Supreme Court and health care law: state sovereignty at stake

The Supreme Court hears various challenges to the health-care law next week. While the individual mandate will be the focus, state sovereignty is also at stake, especially in state reform of health care.

Pablo Martinez Monsivais/AP Photo/File
Justices of the Supreme Court gather for a group portrait. Seated from left are Clarence Thomas, Antonin Scalia, John Roberts, Anthony M. Kennedy, and Ruth Bader Ginsburg. Standing, from left are Sonia Sotomayor, Stephen Breyer, Samuel Alito Jr., and Elena Kagan.

Next week, the US Supreme Court holds three days of hearings on challenges to the health-care law signed by President Obama two years ago. Much of the focus will be on the law’s mandate that individuals must buy private insurance or be fined. But an equally compelling issue is whether the law violates the sovereignty of states.

Just as individuals have rights under the Constitution, states are granted all powers not given to Congress, such as police powers, under the 10th Amendment. The new law erodes that sovereignty in many ways, such as requiring states to spend more on Medicaid. But its biggest impact may be that it hinders the states’ ability to offer alternatives paths to universal health care by not allowing them to exempt their citizens from the mandate.

Since the law’s passage, 14 states have passed measures to guarantee the freedom of their citizens not to buy health insurance. And 26 states are party to the legal challenges to the law. This shows a rigorous assertion of the argument that local government is the best government, especially in the face of a federal law that aims to control an industry that makes up 17 percent of the economy.

In fact, while the high court will try to balance competing federal and state powers in its coming ruling (expected in June), the issue may not be strictly constitutional but rather the best way Americans can change their society in regard to difficult topics such as access to health care.

States have long played a vital role as laboratories for reform, inspiring one another to adopt programs that are proven to work. California, for example, has set stiff air pollution laws, while Arizona is trying ways to curb illegal immigration. Such a role would be further diminished by the heavy hand of this health-care law through its mandates.

Achieving the goal of universal care could be more easily achieved if Washington were to play only a supporting role for states as each tries to meet a popular demand for universal coverage.

In fact, the Supreme Court ruled in 2010 that Congress must “properly” account for state interests when it passes a law that invokes the Constitution’s “Necessary and Proper” clause. That clause could be the focus of next week’s hearings as the Obama administration plans to invoke it as a legal defense in asking the court to uphold the law.

In both these Supreme Court cases and this year’s presidential campaign, the health-care law is reviving a debate over state sovereignty that is as old as the Constitutional Convention of 1787. But this time the issue is linked to the rights of individuals not to be penalized for simply not engaging in an economic activity, such as the health system.

No wonder the court has allowed an unusual three days to hear all the arguments – and to release audio recordings of their sessions soon afterward. Five of the nine justices must then choose wisely on rebalancing this law’s challenge to rights, sovereignty, and freedom.

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