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Obamacare Goes to Court, Analysis: Well, Is This Thing Constitutional or Not?

Evan McMurry
2012 Election
1

The Supreme Court has decided not to skip out the side door, and will decide on the constitutionality of Obamacare, the health care reform bill formerly knows as the Affordable Care Act. Which brings us to the question that has been lingering since before the bill passed in the early hours of 2010: how will the Supreme Court rule?

Today's arguments will center on the portion of Obamacare that establishes a mimimum coverage mandate (hereby knows as the individual mandate), which requires an individual to either purchase a health care or pay a comparable fine. The government will argue that it has every right to create an individual mandate under the Commerce Clause, which allows Congress to regulate interstate economic activity. 

The case against the bill has two parts. The first is theoretical: that the Commerce Clause doesn't apply to the individual mandate, as the government is attempting to regulate economic inactivty--i.e., people choosing not to interact with the economy by not buying insurance. The second is consequential: that allowing the government to regulate economic inactivity will abolish all conceivable restraint over the government's reach; there won't be anyting left the government can't compel you to do.

1st Argument: This argument seems to rest mostly on a rhetorical sleight of hand, that of economic inactivity: people choosing not to buy insurance are technically not engaging in economic activity, which is the purview of the Commerce Clause.

But beyond a linguistic level, this is nonsense. Everybody may not want to buy health insurance, but everybody will eventually need health care; given that health care costs are inextricably linked across society, economic activity with regards to health insurance is inevitable. In other words, when you're not buying health insurance, you are actually engaging in economic activity, that of driving your own and everybody's else costs up. This is one of the primary needs for health care in the first place: when everybody is not paying into a system that everybody eventually uses, it creates higher costs and inequitable treatment. The mandate was created specifically to address this problem.

2nd Argument: This leads into the second case against the individual mandate: if the government can compel you to buy a product, what can't it do? Can the government require everyone to buy only healthy food? Can it require people to buy only American cars?

The Court will want the government to answer these concerns, and may go so far as requiring some sort of line in the sand as to where government intrusion might reasonably stop; the Justice Department will be loathe to do this, as it will not want to have to defend a law passed by a future legislature that goes against a standard it set today.

But it likely won't have to. Fairly clear limitations already exist on federal power, and the government can easily argue that the individual mandate falls within them. As Ian Millhiser at ThinkProgress points out

Congress cannot do lots of things. Broadly speaking, the Constitution gives the federal government sweeping authority to regulate economic matters — like the national health care market — but Congress has far less authority over non-economic matters. For this reason, federal murder laws, assault laws, laws regulating sexual morality or many laws regulating the family are all unconstitutional, but the Affordable Care Act fits clearly within Congress’ constitutional authority.

Expect the government to argue that health insurance is a unique product, as everyone will eventually use it, and it requires national participation to function. As Jonathan Cohn over at The New Republic puts it, "Since getting sick and consuming medical services is inevitable, and since even (most of) the law's critics acknowledge the government can regulate the way sick people pay for their medical care, the mandate is acceptable." This is a narrow argument that the government hopes will protect against any slippery slope criticism.

Let's return to the previous examples. Could the government force you to buy an American made car to, say, boost the national economy? Nope: driving a car is not inevitable, and though "Congress might be able to pass a law requiring everybody to get a car, obtain a transit pass, or, again, pay a fee to offset the costs of future transportation," Cohn writes, the purchase of specific product in this instance would not satisfy the limiting principle set forth by the government.

Eating, however, is inevitable. Could the government then force you to buy healthy food? Probably not, largely because there is no compelling reason to do so: rates of healthy eating could be just as be achieved by, say, putting restrictions on the health standards of food produced. The individual mandate was created in response to a specific and national crisis that centers on individual participation. Buying healthy food would not satisfy this principle.

Health insurance, in short, is a unique product, in that it will be consumed by everybody, but can only function through universal participation. This makes it one national economic activity, clearly under the purview of the Commerce Clause, but without much application to other areas where states or individual rights "have historically been sovereign," in the words of the Justice Department's brief. 

Whether the Supreme Court buys this is anyone's guess; Anthony Kennedy is a strange one. But legal and constitutional scholars are in wide agreement that the individual mandate, whatever its merits as policy and whatever its popularity, is constitutional.

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Related: Does It Matter That Health Care Reform Is Unpopular?

Join: PoliticOlogy, for all your Obamacare-related updates and analysis

Follow: Evan McMurry @evanmcmurry

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