Challenges to President Barack Obama’s health care reform legislation aren’t coming just from Republicans in Congress. Several law suits are challenging the constitutionality of the Patient Protection and Affordable Care Act, too. While various theories are being used to attack the legislation, most focus on the the individual mandate in the PPACA – a provision that requires all Americans to obtain health care coverage starting in 2014.
While the biggest case, brought by 20 states, is being heard in Florida, a Michigan Federal Court judge is the first to actually issue a decision on the merits of the new health care reform law. Judge George Steeh ruled against the plaintiffs, finding that the individual mandate did not exceed the federal government’s authority under the Constitution’s commerce clause. The plaintiffs in the case, who also claimed, among other complaints, that the penalty to be imposed under the law for failing to obtain health care coverage was an illegal tax, have vowed to appeal Judge Steeh’s ruling. Specifically, Judge Steeh denied the plaintiffs request for a preliminary injunction that would have stopped the reforms.
According to the Los Angeles Times, Judge Steeh cited the impact failing to be insured causes on the health care system as a whole. “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, collectively shifting billions of dollars, $43 billion in 2008, onto other market participants….” He also noted that, in the context of a health care reform bill that requires carriers to accept all applicants regardless of their medical condition, an mandate on individuals to be insured would be undermine the nation’s health care system.
This argument, that forcing carriers to guarantee issue coverage without a balancing requirement for consumers to obtain coverage would lead to adverse selection leading to ever higher premiums, is frequently made by policy makers and others (including me) justifying an individual mandate. What’s different is that the judge defines the failure to obtain medical coverage as an economic action that, while locally made, impacts interstate commerce. “[P]laintiffs in this case are participants in the health care services market. They are not outside the market. While plaintiffs describe the Commerce Clause power as reaching economic activity, the government’s characterization of the Commerce Clause reaching economic decisions is more accurate.”
Judge Steeh’s decision is not binding on other courts, although it will no doubt be cited as precedent by the government in defending against the other law suits filed against the PPACA. Decisions in these cases will be coming relatively soon: a suit brought by the Virginia Attorney General is scheduled for a hearing on October 18th while a hearing on the suit in Florida is scheduled for December 16th.
Ultimately, the Supreme Court will no doubt determine the constitutionality of the Patient Protection and Affordable Care Act. Judge Steeh’s decision is simply the first of many court rulings to come.