Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-23T09:49:24.877Z Has data issue: false hasContentIssue false

Congress, Courts, and Commerce: Upholding the Individual Mandate to Protect the Public's Health

Published online by Cambridge University Press:  01 January 2021

Extract

Despite historic efforts to enact the Patient Protection and Affordable Care Act (PPACA) in 2010, national health reform is threatened by multiple legal challenges grounded in constitutional law. Premier among these claims is the premise that PPACA’s “individual mandate” (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is constitutionally infirm. Attorneys General in Virginia and Florida (joined by 25 other states) allege that Congress’ interstate commerce powers do not authorize federal imposition of the individual mandate because Congress lacks the power to regulate commercial “inactivity.” Stated simply, Congress cannot regulate individuals who choose not to obtain health insurance because they are not engaged in a commercial venture. Several courts initially considering this argument have rejected it, but two federal district courts in Virginia and Florida have concurred, leading to numerous appeals and the near promise of United States Supreme Court review.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Patient Protection and Affordable Care Act (PPACA), Pub. L. No. 111148, 124 Stat. 119 (2010).Google Scholar
Id. § 1501 (b) (as amended by § 10106 (b) of Pub. L. No. 111–148 and by § 1002 of Pub. L. 111–152).Google Scholar
Barnett, R., “A Noxious Commandment,” New York Times, December 13, 2010, available at <http://www.nytimes.com/roomfordebate/2010/12/13/a-fatal-blow-to-obamas-health-care-law/an-unconstitutional-commandment> (last visited May 24, 2011).+(last+visited+May+24,+2011).>Google Scholar
Associated Press, “Florida: Six More States Sue over Health Care Law,” New York Times, January 18, 2011, available at <http://www.nytimes.com/2011/01/19/health/policy/19brfs-SIXMORESTATE_BRF.html?_r=2&scp=13&sq=health%20care%20reform%20lawsuit&st=cse> (last visited May 24, 2011).+(last+visited+May+24,+2011).>Google Scholar
U.S. Court of Appeals for the Fourth Circuit, Oral Argument Calendar, 5/10/11–5/13/11 Session, at 2, available at <http://pacer.ca4.uscourts.gov/calendar/internetcalmay102011ric.pdf> (last visited May 29, 2011); U.S. Court of Appeals for the Eleventh Circuit, Affordable Care Act Oral Argument, available at <http://www.ca11.uscourts.gov/documents/pdfs/Health_Care_Act_calendar.pdf> (last visited May 29, 2011).+(last+visited+May+29,+2011);+U.S.+Court+of+Appeals+for+the+Eleventh+Circuit,+Affordable+Care+Act+Oral+Argument,+available+at++(last+visited+May+29,+2011).>Google Scholar
Sack, K., “Federal Judge Rules That Health Law Violates Constitution,” New York Times, January 31, 2011, available at <http://www.nytimes.com/2011/02/01/us/01ruling.html> (last visited May 24, 2011).+(last+visited+May+24,+2011).>Google Scholar
Nagourney, A. Herszenhorn, D. M., “Republicans Call Health Legislation a Tax Increase,” New York Times, October 2, 2009, at A22.Google Scholar
Thomas More Law Ctr. v. Obama, 720 F. Supp. 2d 882 (Mich, E.D. (2010); Liberty Univ., Inc. v. Geithner, — F. Supp. 2d —, 2010 WL 4860299 (W.D. Va. Nov. 30, 2010); Mead v. Holder, — F. Supp. 2d —, 2011 WL 611139 (D.D.C. Feb. 22, 2011).Google Scholar
Thomas More Law Ctr., 720 F. Supp. 2d at 894.Google Scholar
Mead, 2011 WL 611139 at *18; Liberty Univ., 2010 WL 4860299 at *15 (“Far from ‘inactivity,’ by choosing to forgo insurance, Plaintiffs are making an economic decision to try to pay for health care services later, out of pocket, rather than now, through the purchase of insurance.”).Google Scholar
Mead, 2011 WL 611139 at *18.CrossRefGoogle Scholar
Thomas More Law Ctr., 720 F. Supp. 2d at 894 (citing Gonzales v. Raich, 545 U.S. 1, 30 (2005); Wickard v. Filburn, 317 U.S. 111, 127–28 (1942); Heart of Atlanta Motel v. United States, 379 U.S. 241 (1964); Liberty Univ., 2010 WL 4860299 at *15 (citing Wickard, 317 U.S. at 128)(describing Congress' power to regulate “practices affecting” prices in interstate commerce).Google Scholar
Virginia ex rel. Cuccinelli v. Sebelius, 728 F. Supp. 2d 768 (E.D. Va. 2010); Florida ex rel. Bondi v. U.S. Dep't of Health and Human Servs., — F. Supp.2d. —, 2011 WL 285683 (N.D. Fla. Jan. 31, 2011).Google Scholar
Virginia v. Sebelius, 728 F. Supp. 2d at 782.Google Scholar
Id., at 781.Google Scholar
Wickard, 317 U.S. 111 (1942).CrossRefGoogle Scholar
Raich, 545 U.S. 1 (2005).CrossRefGoogle Scholar
E.g., Virginia v. Sebelius, 728 F. Supp. 2d at 777.Google Scholar
Id., at 780.Google Scholar
Id., at 782.Google Scholar
Id., at 781.Google Scholar
Florida ex rel. Bondi v. U.S. Dep't of Health and Human Servs., — F. Supp.2d. —, 2011 WL 285683, *22 (N.D. Fla. Jan. 31, 2011).Google Scholar
Id., at *27.Google Scholar
Id., at *2325.Google Scholar
Id., at *26 (citing United States v. Lopez, 514 U.S. 549 (1995) (striking down Gun Free School Zones Act as beyond Commerce Clause authority).Google Scholar
Id., at *26. However, Judge Kessler pointed out in Mead that the statute struck down in Lopez was not part of any larger regulation of economic activity but was instead an isolated federal criminal statute. Mead v. Holder, — F. Supp. 2d —, 2011 WL 611139, *12 (D.D.C. Feb. 22, 2011).Google Scholar
Florida v. HHS, 2011 WL 285683 at *26.Google Scholar
PPACA § 3011.Google Scholar
Id. § 4103 (Medicare Coverage of Annual Wellness Visit); Id. §§ 4104–4106 (Preventive Services in Medicare) Id. § 4108 (Preventive Services in Medicaid); Id. § 4202 (Evaluation of Community-Based Prevention and Wellness Programs for Medicare Beneficiaries); Id. § 4107 (Medicaid Coverage of Comprehensive Tobacco Cessation Services for Pregnant Women).Google Scholar
Id. §§ 4001–4003, 4201 (Research on the Effectiveness of Preventive Care Services); Id. § 4206 (Demonstration Project for Individualized Wellness Plan).Google Scholar
Id. § 5314 (Fellowship Training in Public Health); Id. § 5315 (U.S. Public Health Sciences Track).Google Scholar
Id. § 2952 (Postpartum Depression); Id. § 2953 (Personal Responsibility Education for Adolescents); Id. § 4004 (Preventive Benefits); Id. § 4102 (Oral Healthcare Prevention); Id. § 4305 (Pain Care); Id. § 10413 (Young Women's Breast Cancer).Google Scholar
Id. § 3502 (Community Health Teams); Id. § 4101 (School-based Health Centers); Id. § 10503 (Community Health Centers and the National Health Service Corps Fund); Id. § 5208 (Nurse-Managed Health Clinics).Google Scholar
Id. § 4304 (Epidemiology-Laboratory Capacity Grants); Id. § 10411 (Congenital Heart Disease).Google Scholar
Id. § 4204 (Immunizations).Google Scholar
Id. § 4205 (Nutrition Labeling of Standard Menu Items at Chain Restaurants).Google Scholar
Institute of Medicine, America's Uninsured Crisis: Consequences for Health and Health Care (2009).Google Scholar
155 Cong. Rec. S11990 (daily ed. Nov. 30, 2009) (statement of Sen. Baucus); Abdullah, et al., “Analysis of 23 million US hospitalizations: Uninsured children have higher all-cause in-hospital mortality,” Journal of Public Health 32, no. 2 (2009): 236244, at 242.CrossRefGoogle Scholar
See Institute of Medicine, supra note 39.Google Scholar
S. Rep. No. 111–89, at 1 (2009).Google Scholar
Id., at 2.Google Scholar
H.R. Rep. No. 111–443, at 984 (2010).Google Scholar
See, e.g., 155 Cong. Rec. S12654 (daily ed. Dec. 8, 2009) (statement of Sen. Udall).Google Scholar
Florida ex rel. Bondi v. U.S. Dep't of Health and Human Servs., — F. Supp.2d. —, 2011 WL 285683, *39 (N.D. Fla. Jan. 31, 2011).Google Scholar
Hodel v. Virginia Surface Min. & Reclamation Ass'n, Inc., 452 U.S. 264, 308 (1981); Gibbons v. Ogden, 22 U.S. 1 (1824).Google Scholar
Hodel, 452 U.S. at 308; United States v. Darby, 312 U.S. 100, 114 (1941).Google Scholar
Hodel, 452 U.S. at 300.Google Scholar
21 U.S.C. § 301–399; United States v. Walsh, 331 U.S. 432, 434 (1947).Google Scholar
United States v. Wiesenfeld Warehouse Co., 376 U.S. 86, 91–92 (1964).Google Scholar
15 U.S.C. § 1331.Google Scholar
42 U.S.C. § 7401 et seq.Google Scholar
29 U.S.C. § 651 et seq.Google Scholar
21 U.S.C. § 801 et seq.Google Scholar
30 U.S.C. § 1202.Google Scholar
18 U.S.C. § 248, United States v. Bird, 401 F.3d 633, 634 (5th Cir. 2005); United States v. Weslin, 156 F.3d 292, 294 (2d Cir. 1998).Google Scholar
United States v. Walsh, 331 U.S. 432, 434 (1947).Google Scholar
Hodel v. Va. Surface Min. & Reclamation Ass'n, Inc., 452 U.S. 264, 268 (1981).Google Scholar
Weslin, 156 F.3d at 294; United States v. Dinwiddie, 76 F.3d 913, 923 (8th Cir. 1996).Google Scholar
United States v. Lopez, 514 U.S. 549 (1995).Google Scholar
United States v. Morrison, 529 U.S. 598 (2000).Google Scholar
Balkin, J. M. Levinson, S., “Understanding the Constitutional Revolution,” Virginia Law Review 87 (2001): 10451109, at 1052–1053; Chemerinsky, E., “The Federalism Revolution,” New Mexico Law Review 31 (2001): 7–30, at 7–8; Gardner, J. A., “The Failed Discourse of State Constitutionalism,” Michigan Law Review 90 (1991): 761, 771–778; Weeks Leonard, E., “Rhetorical Federalism: The Value of State-Based Dissent to Federal Health Reform,” Hofstra Law Review 39 (2010): 111–168, at 131.CrossRefGoogle Scholar
Gonzalez v. Raich, 545 U.S. 1, 2324 (2005).Google Scholar
Freier v. Westinghouse Elec. Corp., 303 F.3d 176, 201–202 (2d Cir. 2002); United States v. Beuckelaere, 91 F.3d 781, 785 (6th Cir. 1996); Dinwiddie, 76 F.3d at 92; Weslin, 156 F.3d at 294; United States v. Leshuk, 65 F.3d 1105, 1112 (4th Cir. 1995).Google Scholar
Raich, 545 U.S. at 9.Google Scholar
Id., at 23.Google Scholar
Id., at 22.Google Scholar
Id., at 17.Google Scholar
Hadley, J. Holahan, J., Kaiser Commission on Medicaid and the Uninsured, The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending?, May 10, 2004, available at <http://www.kff.org/uninsured/upload/The-Cost-of-Care-for-the-Uninsured-What-Do-We-Spend-Who-Pays-and-What-Would-Full-Coverage-Add-to-Medical-Spending.pdf> (last visited May 24, 2011).+(last+visited+May+24,+2011).>Google Scholar
Davis, K., The Commonwealth Fund, “In the Literature: The Costs and Consequences of Being Uninsured,” Medical Care Research and Review 60, no. 2, Supp. (June 2003): 89S-99S, available at <http://www.commonwealthfund.org/∼/media/Files/Publications/In%20the%20Literature/2003/Jun/The%20Costs%20and%20Consequences%20of%20Being%20Uninsured/davis_consequences_itl_663%20pdf.pdf> (last visited May 24, 2011).Google Scholar
Hadley, J., Kaiser Commission on Medicaid and the Uninsured, “Sicker and Poorer – The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income,” Medical Care Research and Review 60, no. 2, Supp. (June 2003): 3S75S, at 60S, available at <http://www.kff.org/uninsured/upload/Supplement-article-by-Jack-Hadley.pdf> (last visited May 24, 2011).CrossRefGoogle Scholar
PPACA §§ 20012004.Google Scholar
Id. § 5601.Google Scholar
Id. §§ 1513, 10106.Google Scholar
Id. § 1421.Google Scholar
Id. §§ 1301, 1302, 1322, 1334, 1401, 1402, 10104.Google Scholar
Id. §§ 1101, 1201, 1341, 10103.Google Scholar
Buettgens, M. Garrett, B. Holahan, J., “Why the Individual Mandate Matters,” Urban Institute Timely Analysis of Immediate Health Policy Issues, December 2010, available at <http://www.rwjf.org/files/research/71601.pdf> (last visited May 24, 2011).+(last+visited+May+24,+2011).>Google Scholar