Obamacare Case - Artikel

In 2010, Congress enacted the Patient Protection and Affordable Care Act, 124 Stat. 119, to increase the number of Americans covered by health insurance and decrease the cost of health care. This case concerns constitutional challenges to two key provisions, the individual mandate and the Medicaid expansion.

The individual mandate requires Americans to maintain ‘minimum essential’ health insurance coverage. Many individuals will receive this through their employer, or from a government program such as Medicaid or Medicare. Those who do not receive health insurance through a third party should purchase insurance from a private company. Beginning in 2014, those who do not comply with the mandate must make a “[s]hared responsibility payment” to the Federal Government. This “penalty,” is calculated as a percentage of household income, subject to a floor based on a specified dollar amount and a ceiling based on the average annual premium the individual would have to pay for qualifying private health insurance.
The second provision of the Affordable Care Act challenged is the Medicaid expansion. Enacted in 1965, Medicaid offers federal funding to States to assist pregnant women, children, needy families, the blind, the elderly, and the disabled in obtaining medical care. See 42 U. S. C. By 1982 every State had chosen to participate in Medicaid. Federal funds received through the Medicaid program have become a substantial part of state budgets. When a State doesn’t comply with the new requirements, it may lose all of its federal Medicaid funds.

Arguments from the government:

First, the Government argues that Congress had the power to enact the mandate under the Commerce Clause. Congress may order individuals to buy health insurance because the failure to do so affects interstate commerce, and could undercut the Affordable Care Act’s other reforms.

Second, the Government argues that if the commerce power does not support the mandate, we should nonetheless uphold it as an exercise of Congress’s power to tax. According to the Government, even if Congress lacks the power to direct individuals to buy insurance, the only effect of the individual mandate is to raise taxes on those who do not do so, and thus the law may be upheld as a tax.

But Congress has never attempted to rely on that power to compel individuals not engaged in commerce to purchase an unwanted product. Legislative novelty is not necessarily fatal; there is a first time for everything. But sometimes “the most telling indication of [a] severe constitutional problem . . . is the lack of historical precedent” for Congress’s action.

The power to regulate commerce presupposes the existence of commercial activity to be regulated. If the power to “regulate” something included the power to create it, many of the provisions in the Constitution would be superfluous.

The individual mandate doesn’t regulate existing commercial activity. It compels individuals to become active in commerce by purchasing a product, on the ground that their failure to do so affects interstate commerce.

Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority.

The government also pointed that many Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance. The failure of that group to have a healthy diet increases health care costs, to a greater extent than the failure of the uninsured to purchase insurance.

People often fail to do things that would be good for them or good for society. Those failures can have a substantial effect on interstate commerce. Under the Government’s logic, that authorizes Congress to use its commerce power to compel citizens to act as the Government would have them act.

The individual mandate’s regulation of the uninsured is particularly divorced from any link to existing commercial activity. The mandate primarily affects healthy, often young adults who are less likely to need significant health care and have other priorities for spending their money. It is precisely because these individuals, incur relatively low health care costs that the mandate helps counter the effect of forcing insurance companies to cover others who impose greater costs than their premiums are allowed to reflect. The Government regards it as sufficient to trigger Congress’s authority that almost all those who are uninsured will, at some point in the future, engage in a health are transaction.

Congress can anticipate the effects on commerce of an economic activity. There is never permitted Congress to anticipate that activity itself in order to regulate individuals not currently engaged in commerce. The Government argues that the individual mandate can be sustained as a exception, because health insurance is a unique product. “[h]ealth insurance is not purchased for its own sake like a car or broccoli; it is a means of financing health-care consumption and covering universal risks.” But cars and broccoli are no more purchased for their “own sake” than health insurance. They are purchased to cover the need for transportation and food.

It says that health insurance and health care financing are “inherently integrated.” That doesn’t mean the compelled purchase of the first is properly regarded as a regulation of the second. No matter how “inherently integrated” health insurance and health care consumption may be, they involve different transactions, entered into at different times, with different providers.

The proximity and degree of connection between the mandate and the subsequent commercial activity is too lacking to justify an exception of the sort urged by the Government. The individual mandate forces individuals into commerce precisely because they elected to refrain from commercial activity. Such a law cannot be sustained under a clause authorizing Congress to “regulate Commerce.”