Health Care Law

  • March 9, 2012

    by Jeremy Leaming

    The Supreme Court has set aside a large chunk of time later this month to hear argument over the constitutionality of the health care law’s integral provision, but the primary argument against the minimum coverage provisions has been loudly and repeatedly bandied about since the law’s enactment.

    The law’s minimum coverage provision requires people who can afford it to obtain a minimum coverage of health insurance or pay a penalty when filing their income tax returns. It’s not the only provision being challenged by the states, but it is the one that has largely driven the right-wing argument that if the federal government can force some people to purchase health care insurance, there’s no limit to what Congress will be able to require individuals to purchase. (Maybe Congress will require everyone to purchase a gun, to protect their lives, from predators. While becoming a target of crime is obviously something that does and can happen anywhere in the world, it is not as certain as humans’ need for medical treatment due to many other causes, many natural.)

    As noted on ACSblog numerous times, the liberty argument is not only wobbly, but hypocritical. A former U.S. Solicitor General Walter Dellinger noted at last year’s ACS Convention that many of the folks complaining about the minimum coverage provision are also supporters of laws requiring women to undergo sonograms and listen to propaganda from doctors before receiving an abortion.

    In a March 7 piece for The Nation, Georgetown University law school professor and constitutional law expert David Cole provides, as usual for the professor, an accessible explanation about why the argument against the minimum coverage provision is unlikely to be invalidated by the high court.

    Not only is the argument against the minimum coverage provision on flimsy ground, it’s also not conservative. The argument is, in reality, “radically libertarian,” Cole writes.

    Cole states:

    We’ve seen this kind of libertarian constitutional argument before. In the early twentieth century, after the Industrial Revolution had concentrated economic power in employers’ hands, Congress and the states passed many laws designed to protect workers from exploitation. Time and again, the Supreme Court invalidated these statutes. It deemed the federal laws beyond Congress’s power to regulate interstate commerce because they were said to regulate the terms of production, manufacture or mining, all of which were said to precede interstate commerce. And it invalidated state labor laws as infringements on the “freedom of contract” protected by the due process clause.

    After the Depression, however, the court “overruled both lines of precedent it abandoned altogether the due process notion that economic regulation infringes on ‘freedom of contract,’” and “it has never since invalidated any law on that ground. And it ruled that in our integrated national economy, Congress is entitled to regulate on the presumption that all economic activity, not matter how local, affects interstate commerce.”

  • February 8, 2012

    by Jeremy Leaming

    Opponents of the Affordable Care Act’s provision that requires people who can afford it to obtain minimum health insurance coverage or pay a penalty with their annual income tax return have loudly argued that it upsets the balance between the regulatory powers of the federal government and state governments.

    But in a recent piece for The Times-Picayune, a New Orleans daily, distinguished law professor at the University of Southern California Rebecca L. Brown says the federalism argument is “false.”

    First she notes there is “no serious argument that health care and insurance purchasing are not economic, or that they affect purely local interests – the arguments in all prior Commerce Clause challenges.” (Indeed the Constitution’s commerce clause provides Congress the authority to regulate conduct that substantially affects interstate commerce. The health care market accounts for more than 17 percent of the U.S. economy, and everyone, at some point, participates in it or is constantly at risk of incurring substantial medical expenses.)

    Opponents of the law are aware of the parameters of the commerce clause and federal court precedent surrounding it, and are actually pushing an individual-rights argument. “The Affordable Care Act challenge,” Brown writes, “powerfully evokes that libertarian tradition by arguing that the requirement to purchase health insurance invades personal decision-making.”

    But that argument, Brown continues, is as wobbly as the federalism argument.

  • January 6, 2012

    by Jeremy Leaming

    The Obama administration’s signature domestic achievement, the Patient Protection and Affordable Care Act, which requires many people to purchase health care coverage in 2014, is a reasonable and constitutional means to provide millions of uninsured with health care coverage, the Department of Justice argues in a brief lodged today with the Supreme Court.

    The brief “arguments track the Obama administration’s arguments before lower courts,” Brian Beutler reports for TPM, which also provides access to the 130-page document.

    As Beutler notes, the DOJ explains why the law’s so-called individual mandate is a constitutional means to help millions of Americans afford health insurance. The law bars insurance companies from denying coverage or charging more to people who have pre-existing medical conditions. For that provision of the law to work, however, the law must require individuals who can afford health insurance to obtain minimum coverage or pay a penalty via their annual income tax returns.

    The DOJ’s brief argues that the law is a permissible regulation under its constitutional authority to regulate commerce and its taxing power.

    The federal government already regulates the health care market – Medicare and Medicaid are examples. However, millions of people, because of a lack of additional regulation have been unable to afford health care insurance or been denied it because of preexisting conditions.

    The DOJ argues that the law’s so-called individual mandate will bridge the gap.

    “The uninsured shift tens of billions of dollars of costs for the uncompensated care they receive to other market participants annually,” the brief states. “That cost-shifting drives up insurance premiums, which, in turn, makes insurance unaffordable to even more people.”

  • September 28, 2011

    by Jeremy Leaming

    The Obama administration is urging the U.S. Supreme Court to overturn a federal appeals court opinion that a major provision of the landmark Affordable Care Act is unconstitutional.

    In August, a three-judge panel of the U.S. Court of Appeals for the Eleventh Circuit ruled 2-1 that the individual responsibility provision, or the individual mandate, which requires some people to carry a minimum amount of health care coverage starting in 2014 is unconstitutional.

    The administration decided to skip asking the entire Eleventh Circuit to reconsider the panel’s ruling. The panel’s opinion was swiftly panned by an array of constitutional law experts and legal pundits. The Atlantic’s Andrew Cohen blasted the Circuit’s majority opinion as sounding frequently like a “political manifesto.” He continued, “Had its language been made public just one day earlier, for example, you can bet your last pork-chop-on-a-stick that it would have been anthemized at the Republican debate in Iowa.”

    During an ACS press briefing on the Eleventh Circuit panel decision, ACS Board Chair and University of Chicago law school professor Geoffrey R. Stone said, “[I]f you gave this case, for example, to a group of law students who didn’t have any particular views on the merits but just as a legal exercise, and you gave them the existing precedents, I think they would have no difficulty upholding the legislation.” Audio of the briefing is available here.

    In announcing its action in defense of the ACA’s integral provision, the Department of Justice said:

    The Department has consistently and successfully defended this law in several court of appeals, and only the 11th Circuit Court of Appeals has ruled it unconstitutional. We believe the question is appropriate for review by the Supreme Court.

    Throughout history, there have been similar challenges to other landmark legislation such as the Social Security Act, the Civil Rights Act, and the Voting Rights Act, and all of those challenges failed.  We believe the challenges to Affordable Care Act — like the one in the 11th Circuit — will also ultimately fail and that the Supreme Court will uphold the law.

    Earlier in the summer, a panel of the U.S. Court of Appeals for the Sixth Circuit upheld the ACA’s mandate, holding, in part, “The minimum coverage provision regulates activity that is decidedly economic.”

  • June 30, 2011
    Guest Post

    By Simon Lazarus, Public Policy Counsel to the National Senior Citizens Law Center, author of two ACS issue briefs on the constitutionality of the Affordable Care Act’s individual responsibility provision, or “individual mandate,” and a frequent contributor to this blog and other blogs and periodicals. Lazarus’s ACS Issue Briefs are available here and here.


    As the various health reform legal challenges have proceeded through lower federal courts respectively hospitable and hostile, all parties, participants, and observers have agreed that in the end, the Supreme Court will resolve the fate of the Affordable Care Act’s (ACA) individual mandate to carry health insurance, paying little heed to the conflicting opinions of lower court judges.  But that assumption may need to be revisited, in light of Sixth Circuit Judge Jeffrey Sutton’s decision to join Carter appointee Boyce Martin in yesterday’s 2-1 ruling upholding the constitutionality of the ACA mandate.  It is just possible that Sutton’s 27-page opinion could be one to which members of the high court’s conservative bloc will give serious attention. 

    In part, that’s because of who Sutton (pictured) is.  Not only is he the conservative justices’ philosophical kin.  More important, he is their intellectual peer.  As noted on the conservative Volokh Conspiracy blog by Orin Kerr, “Judge Sutton is a Federalist Society favorite, one of Justice Scalia’s favorite former clerks, and a regular ‘feeder’ judge to the Supreme Court. As a result, what Judge Sutton thinks about the constitutionality of the mandate actually matters a lot to the future debate over the mandate.”

    But more important than the pedigree of the author of this opinion is its content.  Of the – so far – four opinions upholding the mandate (by three district judges and by Judge Martin in the same case) Sutton’s methodical and bombast-free analysis is the most comprehensive in dissecting the issues raised by all the arguments devised by ACA opponents.

    Strategically, Sutton frames his argument as a right-leaning legal and policy wonk speaking to a Federalist Society conference, or a meeting with like-minded jurists.  In addition, Sutton acknowledges throughout that he is but a “middle-management judge,” respectfully mindful that his superiors on the Supreme Court will have the last word.  The argument clearly recognizes that, at bottom, this litigation is the latest phase of a fierce three decade-old war between two schools of conservative constitutionalism: on the one hand, the long dominant mainstream conservative vision celebrating judicial restraint, respect for precedent, and deference to elected decision-makers; on the other, libertarian anti-government activism, which had been confined to a small cadre of fervent but marginalized enthusiasts until 2010, when the tea party mobilized and opposition to ACA became Republican Party orthodoxy.  In light of his own history as a fervent promoter of a states’ rights-oriented concept of “federalism,” Sutton would have surprised no one had he gone with the new flow and come down hard against the mandate.  Instead, his opinion is an unambiguous recommendation to traditional conservatives, specifically, Justices Scalia, Kennedy, and Roberts, to stick to their knitting and leave this explosive policy debate to legislators and voters. 

    Sutton’s bottom-line holding that the Commerce and Necessary and Proper clauses authorize the mandate closely resembles his Democratic colleague Judge Martin’s opinion; indeed, prominent libertarian ACA opponent  Ilya Somin (who has twice appeared on ACS panels) termed theirs  the "Martin-Sutton approach" with “extremely radical implications” more “sweeping” than the three previous district court decisions favorable to the Obama administration.  But unlike Martin, who held it unnecessary to reach the question whether the mandate could be justified as an exercise of Congress’ tax-and-spend authority, Sutton began his opinion by elaborately rejecting the administration’s arguments in support of that claim.   Perhaps that introduction could remind readers, especially conservative readers, that the opinion’s author is no knee-jerk defender of Congressional prerogatives or the hated ACA in particular.