Auto Insurance Quotes ~ Is the Affordable Care Act constitutional? The score is 3 to 2 : Three Democratic U.S. district judges ruled that the Affordable Care Act's mandate requiring individuals to buy at least a minimum amount of health insurance is constitutional. Two Republican U.S. district judges declared the mandate unconstitutional. Several more district court cases are pending. It appears the judgments are a matter of political perspective.
Four of the judges limited their decisions principally to the constitutionality of the mandate. However, in a suit filed by 26 states, Florida Judge Roger Vinson ruled the entire act unconstitutional because the individual mandate was "inextricably bound together" with the remainder of the act's provisions.
He bolstered his opinion on the Obama administration's very argument that the ACA is constitutional because the mandate is absolutely essential to achieving the ACA's other provisions for reforming the health-insurance market.
Examples of other provisions include the prohibition against canceling an insurance policy based on health status or rejecting people with pre-existing conditions. Everyone is correct. Without the mandate, the ACA falls apart; providing health coverage to all Americans would be impossible.
Here is the major constitutional question: Unquestionably, Congress has the power to regulate the insurance industry. But did Congress exceed its authority to regulate interstate commerce granted by the Constitution's Commerce Clause by mandating individuals to buy health insurance or pay a penalty? Or more particularly, can Congress penalize individuals for not buying health insurance? That would entail people being penalized for "inaction" rather than an "action"; that is, penalized for not engaging in commerce.
Universal enrollment spreads the financing of health insurance over the entire population. It also eliminates adverse selection, and interrupts the cost-shifting of medical expenses of the uninsured, who are apt to receive care at no cost, to the insured, hospitals and physicians. Cost-shifting increases the price of medical services and causes premiums to rise.
This is also why the mandate is essential for providing health coverage to all Americans.
In fact, although generous subsidies were already available, the individual mandate in Massachusetts proved to be imperative in bringing the healthy uninsured into its state program.
To be constitutional, however, the mandate must also be essential for the ACA to substantially redesign the insurance industry and rise to the stature of a "broader regulatory scheme." Indeed, the mandate is necessary and the ACA meets this standard.
This legal matter will probably find its way to the Supreme Court, especially if appellate courts offer conflicting opinions. The court may also consider the question of whether health care is a unique situation in which people can be required to buy something (but not serve as precedent for other situations). Apparently, issues of personal liberty and requiring states to expand Medicaid are not constitutional issues in question.
But here's the irony of the Republican push to overturn the ACA on the constitutionality of the individual mandate: The ACA was created to both rescue the country from an unsustainable health-care system and preserve the private health-insurance industry. If the individual mandate is necessary to expand health coverage to all but is determined to be unconstitutional, then the only alternative would be what Republicans loathe -- a single-payer system.
There are no constitutional issues regarding a government-benefit program funded by taxes. It's been called "Medicare for all."
OK, understanding that some will say that Dr. Feldman should stick to medical issues, here's my humble opinion:
The individual mandate is constitutional. Congress concluded, with rational justification, that individual decisions regarding the purchase of health insurance profoundly affect the insurance marketplace, thus substantially affecting interstate commerce. Since everyone will eventually require medical care, the "inaction" of not procuring health insurance is actually an "action" that financially affects others.
