Obama health care law at Supreme Court: mega case for the history books
US Supreme Court takes up the Obama health-care reform law starting Monday. The case puts the high court center stage in a constitutional showdown that could define the scope of congressional power for generations – and perhaps affect Obama's reelection prospects.
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Republicans, who want a smaller, limited national government, say requiring an individual to purchase something is not legitimate Commerce Clause regulation.Skip to next paragraph
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Republicans attack the health-care law as a job killer and as an anchor around the neck of a still-wheezing economy. Democrats brush the attacks aside and defend the measure as a necessary reform to make health care more affordable to an estimated 50 million uninsured Americans.
The centerpiece of the law is its requirement that every American purchase health insurance.
This is a reasonable regulation, the president and other supporters say, because virtually everyone will, at some unpredictable moment, require medical care and hospitalization.
"No one is more than an instant from needing health care," Solicitor General Donald Verrilli wrote in his brief to the court.
Opponents attack the individual mandate as a solution to a problem of Congress's own making. The mandate, they say, is being used to assemble a broad enough pool of healthy Americans to underwrite expensive provisions in the bill – like the ban on insurance companies charging higher premiums for those with costly preexisting medical conditions.
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They also say the mandate marks a sharp departure from traditions of American liberty and the Founders' concept of shared federal-state power.
They say if the federal government can simply order Americans to buy a product – like insurance for health care, or broccoli to support a healthy diet, or a Chevy to bail out the US auto industry – there is nothing Congress can't order citizens to do.
"The power to compel a person to enter into an unwanted commercial relationship is not some modest step necessary and proper to perfect Congress' authority to regulate existing commercial intercourse," writes Washington lawyer Paul Clement in his brief to the court on behalf of Florida and 25 other states. "It is a revolution in the relationship between the central government and the governed."
Two views of 'individual mandate'
Solicitor General Verrilli rejects such dire warnings. He says the minimum coverage provision is part of a comprehensive regulatory scheme that is necessary to keep insurance rates affordable for all.
Without the mandate, uninsured individuals would wait until they were sick to purchase insurance, or they might continue to receive uncompensated care and thus continue to shift the cost to existing policyholders, the law's supporters say.
Opponents of the law argue that the ACA seeks to regulate the inactivity of non-policyholders by characterizing the decision not to obtain health insurance as a form of economic activity that can be regulated by the federal government because it ultimately affects the interstate health insurance market.
"Forcing people into commerce does not regulate commerce," Washington lawyer Michael Carvin wrote in his brief.
Mr. Carvin suggests the individual mandate is being used by the government to conscript healthy individuals into the system to help pay for the reforms.
"The mandate's primary purpose and effect is not to regulate uninsured individuals engaging in harmful economic activity, but to compel the uninsured into engaging in economic activity that is harmful for them but beneficial to third parties," he wrote.
Without the mandate, the ACA's requirement that private insurance companies not deny coverage based on a patient's prior medical history would cause a substantial increase in insurance rates. To offset that increase, the law seeks to have young, healthy Americans buy a required level of health insurance – anticipating that most of them will not need it. The new premiums would help pay the extra cost of expanding insurance coverage to low-income Americans and those with expensive preexisting medical conditions.