The magic potion

Affordable Health Care Act heads to U.S. Supreme Court

By Jack Stevenson

The health care legislation promoted by the Obama administration and developed into law by the U.S. Congress, the Affordable Health Care Act, will be reviewed by the U.S. Supreme Court to determine whether the law is constitutional. According to the Associated Press news agency, 26 states have filed legal challenges to the new health insurance law. The U.S. Court of Appeals in Atlanta, Georgia, ruled that the U.S. Constitution does not confer to the United States Congress the authority to require private citizens to buy medical insurance from a commercial for-profit insurance company. The U.S. Supreme Court will hear the case in March and will probably release a decision this summer.

The requirement for individuals to purchase medical insurance is called the “individual mandate.” The U.S. Supreme Court may decide if either the interstate commerce clause or the tax clause of our Constitution grants Congress the authority to impose a “mandate” that requires individual citizens to purchase medical insurance.

If you and your friends were discussing the merits of universal health care, it seems unlikely that anyone would suggest that it depends on the interstate commerce clause of our constitution. But that is exactly the issue before the Supreme Court or, at least, one of the issues. The U.S. Constitution grants the U.S. Congress authority to “lay and collect taxes” and also grants Congress the authority to “regulate commerce. . .among the several states” (interstate commerce). That yields a question: Does the requirement for individual citizens to buy health insurance from a for-profit insurance company constitute interstate commerce? If the answer is yes, then the Congress acted within its authority.

Another argument is that the requirement to purchase medical insurance or pay a financial penalty for failure to purchase insurance is actually a tax. The U.S. Constitution grants Congress the power to tax. The Court may decide whether the insurance purchase or penalty for failure to purchase is a tax. If it is not a tax, then the health insurance law could not be justified by the constitutional tax clause.

The Affordable Health Care Act also expands the Medicaid program. Medicaid is administered by the several states and the cost is shared by the federal government and the states. The adjutants general of 26 states object to the burden placed on the states by expansion of the program and contend that it constitutes federal “coercion” of the states. The Supreme Court will hear their argument.

The Court will also consider the relevance of the 19th century Anti-Injunction Act. The argument, here, is that the court should not decide an issue prematurely, that is, before the law is implemented. The major provisions of the Affordable Health Care Act take effect in 2014. Reliance on the Anti-Injunction Act doctrine would delay any Supreme Court challenge to the health care law until the year 2015. If the Supreme Court adopts this view, the Court would, we assume, not decide the individual mandate issue at the present time. However, the health care law runs to 975 pages, and it contains other miscellaneous provisions that the Court may or may not decide.

The new law requires insurance coverage from birth to age 65 when a citizen becomes eligible for U.S. Government Medicare. Forty percent of lifetime medical costs occur during those first sixty-five years of life. The commercial for-profit insurance companies will collect premiums for 65 years and sustain 40 percent of the lifetime medical costs. Sixty percent of medical costs occur after age 65 and become the responsibility of the tax supported U.S. Government Medicare program.

Supreme Court decisions are difficult to predict. However, the current Supreme Court headed by Chief Justice Roberts has been friendly to business organizations. The Affordable Health Care Act diverts a river of money, a continuous income stream, from citizens to health insurance corporations.

Whether the health insurance law, if implemented, will result in delivery of good health care, remains to be learned. During the past 79 years, 13 presidential administrations have looked at the health care question. None, to date, has found the magic potion.