As the Supreme Court prepares to hear arguments next week on the constitutionality of the Affordable Care Act, most legal experts expect the court to uphold the law . I’m not a constitutional scholar or even a lawyer (and who knows what this court will do), but applying facts and reason to the plaintiffs’ case would result in an easy win for the ACA. The two main arguments in the case against the ACA are that the Medicaid expansion is coercive and the Individual Responsibility Requirement exceeds Congressional authority under the Commerce Clause.
Let’s take these contentions in turn; first, the Medicaid argument. Ask yourself: Does Congress have the authority to repeal the Medicaid statute? (Answer: of course, yes). Second: Can they pass a new program that is purely voluntary for states that provides federal support for state health coverage programs provided those programs conform to eligibility rules determined by Congress? Again, yes - no brainer. So…case over. This argument is just plain lacking in merit.
Now let’s look at the attack on the Individual Responsibility Requirement (IRR). You don’t even need to get as far as the Commerce Clause to dismiss this argument. The reason is that the plaintiffs’ contention does not align with the facts. The argument that the ACA forces people to buy health insurance, the heart of the opposing argument, is simply untrue. For people who don’t have employer- sponsored insurance, the ACA rebalances the financial calculus that determines whether people will purchase insurance. It changes the equation by substantially reducing the cost of being insured (via tax credits) and by modestly increasing the cost of being uninsured via penalties for those who can afford, but do not purchase coverage. There is no true mandate, no forced enrollment and no legal sanctions for failure to purchase coverage. Although people react differently to subsidies and tax penalties, in reality, they are not that different. They both operate to change the cost of making a decision to purchase insurance or not, without compelling any particular decision. You can read a similar argument that is heavy on the legalese here.
Long story short—the real question in this case is whether the conservatives on the Supreme Court can separate out their political preferences and rule on the merits. If the answer is yes, the ACA will be easily upheld, but from the folks, at least some of whom brought us Bush v. Gore, anything is possible.
-- Michael Miller, Policy Director