Health Reform and the Supreme Court
Precedent Would Give Reform Law Resounding Victory
The U.S. Supreme Court’s decision to review the constitutionality of health care reform means it will be issuing a ruling in the middle of the 2012 presidential campaign. This can be a highly politicized court, and, for the public good and its own credibility, it must resist that impulse.
If the court follows its own precedents, as it should, this case should not be a close call: The reform law and a provision requiring most people to obtain health insurance or pay a penalty are clearly constitutional.
The court agreed to hear appeals from a ruling by the U.S. Court of Appeals for the 11th Circuit, which struck down the individual mandate to buy health insurance but left other parts of the law standing. Opponents of the law contend that Congress went beyond its authority in the reform measure. But Congress, under the commerce clause, plainly has the power to regulate the national health care market.
Almost everyone needs health care at some point, and if uninsured people are unable to pay steep medical bills they will get charity care that shifts the costs to others, whose insurance premiums go up to cover the cost of the free riders. There is no denying the health care market is interconnected and that individuals’ decisions to purchase insurance--or not--affects the whole system.
Republican-appointed judges on two appellate courts have found the insurance mandate constitutional. They have cogently pointed out that past Supreme Court decisions have upheld federal laws that were much more intrusive on personal liberty and involved activities less clearly relevant to interstate commerce. These include rulings on laws that prohibit a farmer growing wheat for his own family’s use and a woman growing marijuana for her own medicinal use. There is also no doubt that Congress has the authority to set minimum-wage rates and other laws that affect an individual’s economic decisions. As Judge Laurence Silberman of the U. S. Court of Appeals for the District of Columbia Circuit wrote last week in upholding the health reform law, “the right to be free from federal regulation is not absolute, and yields to the imperative that Congress be free to forge national solutions to national problems, no matter how local--or seemingly passive--their individual origins.”
In addition to reviewing the mandate, the Supreme Court will also consider three other questions: whether other parts of the law are voided if the mandate is struck down; whether a decision must be put off until 2015 when the first penalties by noncompliant individuals would be paid; and whether Congress can require states to expand Medicaid programs in 2014.
If the justices were to strike down the mandate, they would have to consider whether that provision can be eliminated without excising some or all of the rest of the law. Without the mandate, it will be difficult for health insurers to accept all applicants and charge them premiums without regard to their health status. But there is no constitutional reason to strike down those other popular insurance reforms.
The reform law’s expansion of Medicaid coverage to many individuals who are not now covered also has been challenged by the states as unconstitutional coercion because they claim to have no option but to comply. In rejecting that argument, the 11th Circuit noted that the federal government would bear most of the costs of the program’s expansion. Moreover, it found that the states had ample powers to develop alternative programs if they want to drop out of Medicaid.
All of these issues are best resolved in the political system, not the courts. The Supreme Court ought to show judicial restraint, adhere to precedent and uphold the constitutionality of health care reform.