The Supreme Court made the right decision in upholding the controversial Patient Protection and Affordable Care Act. Many thought the decision would come down to whether Congress had the power under the Commerce Clause of the Constitution to force citizens to purchase health insurance.
As it turned out, Congress did not have the power to force citizens to purchase health insurance under the Commerce Clause. In the end, that didn’t matter because Congress does have the power to lay and collect taxes—including any taxes that may arise from choosing not to purchase health insurance.
The big constitutional question that garnered the most attention was whether Congress had the power to regulate commerce in a way that would force the hand of citizens. This portion of the Affordable Care Act is referred to as the individual mandate portion.
It is important to understand that Congress only has as much power as the Constitution gives it. One such power is the power to regulate Commerce. It is referred to as the Commerce Clause and can be found in Article 1, Section 8 of the U.S. Constitution. That Section grants Congress the power “[t]o regulate Commerce with foreign Nations, and among the several States. . . .” That may read like a bunch of mumbo jumbo to many, but it is the language in that sentence that was the basis for the challenge of the Affordable Care Act.
The question on the table was whether regulating commerce included the ability to force someone to participate in said commerce. The Court decided that the answer was no. It reasoned that forcing participation would be creating commerce rather than regulating commerce. Nat’l Fed’n of Indep. Bus. V. Sebelius, Sec’y of Health & Human Serv., 2012 WL 2427810 (2012). The Court had previously only allowed Congress to regulate activity, but the Affordable Care Act would compel “individuals to become active in commerce. . . .” Id. For that reason, the Supreme Court decided that Congress did not have the power under the Commerce Clause to enforce the individual mandate.
Many people, including myself, believed that if the Supreme Court did not find the individual mandate to be constitutional under the Commerce Clause that there would be no hope in saving the Act. In fact, I think many supporters of the Act cringed when they learned that Chief Justice Roberts, a conservative leaning Justice, was authoring the Court’s opinion. Chief Justice Roberts, however, surprised everyone by finding the individual mandate constitutional under Congress’s power to lay and collect tax.
Another one of the many powers Congress has is the power to lay and collect taxes, which can also be found in Article 1, Section 8 of the U.S. Constitution. The issue was whether the individual mandate, which requires those who do not have health insurance to pay a “penalty,” could be considered a “tax.” After all, the Act itself didn’t refer to the requirement as a tax but as a penalty.
Ultimately, the Supreme Court determined that it didn’t matter whether the requirement was labeled a penalty or a tax, because the provision functioned as a tax. It also didn’t matter if the provision was put in place to influence conduct, i.e., to purchase health insurance. Imposing taxes to influence conduct is nothing new to the United States of America. Id. The Court noted that “federal and state taxes can compose more than half the retail price of cigarettes, not just to raise more money, but to encourage people to quit smoking.” Id. That’s exactly what the Affordable Care Act, does: it influences people to purchase health insurance and the Court has found this individual mandate to be constitutional.
What this will mean for individual citizens is still a little unclear. The Act has many positives provisions, including banning insurance companies from denying coverage to those with pre-existing conditions, requiring insurance companies to provide coverage for preventative health care at no extra cost, and requiring employers with more than 50 employees to provide health insurance to those employees.
However, I’m still not sure how this Act will help someone like me. I work for an employer with less than 50 employees and I don’t have any pre-existing conditions; yet, I still can’t afford a realistic private health insurance plan, and forcing me to purchase one won’t help to make it affordable. In fact, I can’t find a private health insurance plan that provides maternity coverage. That doesn’t mean there won’t be options for people like me when the Act goes fully into effect, but it does mean that planning for my family’s future is difficult.
I am sure of one thing, however: so long as the Affordable Care Act remains intact, by the middle of 2014 or so, my knee, which has needed surgical repair for the last five years, will be much happier with me.
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