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A big win for the Affordable Care Act

By Ezra Klein,

Thus far, the court rulings on the Affordable Care Act have exhibited a perfect partisan split: Republican-appointed judges have ruled against the law, while judges appointed by Democrats have ruled for it. Today was the first break in that pattern, as the Sixth Circuit Court of Appeals, which included a George W. Bush appointee who clerked for Antonin Scalia, upheld the law’s constitutionality. You can read the full ruling here (pdf). Here’s the key bit:

Why construe the Constitution, moreover, to place this limitation — that citizens cannot be forced to buy insurance, vegetables, cars and so on — solely in a grant of power to Congress, as opposed to due process limitations on power with respect to all American legislative bodies? Few doubt that the States may require individuals to buy medical insurance, and indeed at least two of them have. The same goes for a related and familiar mandate of the States — that most adults must purchase car insurance. Yet no court has invalidated these kinds of mandates under the Due Process Clause or any other liberty-based guarantee of the Constitution. That means one of two things: either compelled purchases of medical insurance are different from compelled purchases of other goods and services, or the States, even under plaintiffs’ theory of the case, may compel purchases of insurance, vegetables, cars and so on. Sometimes an intuition is just an intuition.
For now, whatever else may be said about plaintiffs’ activity/inactivity theory of commerce power, they have not shown that the individual mandate exceeds that power in all of its applications. Congress may apply the mandate in at least four settings: (1) to individuals who already have purchased insurance voluntarily and who want to maintain coverage, but who will be required to obtain more insurance in order to comply with the minimum-essential-coverage requirement; (2) to individuals who voluntarily obtained coverage but do not wish to be forced (at some indeterminate point in the future) to maintain it; (3) to individuals who live in States that already require them to obtain insurance and who may have to obtain more coverage to comply with the mandate or abide by other requirements of the Affordable Care Act; and (4) to individuals under 30, no matter where they live and no matter whether they have purchased health care before, who may satisfy the law by obtaining only catastrophic-care coverage. The valid application of the law to these groups of people suffices to uphold the law against this facial challenge.

The opinion ends with a pointed reminder that the Supreme Court has traditionally “erred on the side of allowing the political branches to resolve the conflict,” and an assurance that “time assuredly will bring to light the policy strengths and weaknesses of using the individual mandate as part of this national legislation, allowing the peoples’ political representatives, rather than their judges, to have the primary say over its utility.”

Correction: In the original text of this post, I said that the Fourth Circuit Court of Appeals had also upheld the Affordable Care Act. That’s wrong. We’re still awaiting their ruling, though the composition of the panel — two Obama nominees and one Clinton nominee — and the initial oral arguments were so favorable to the law that it’d be shocking if they didn’t uphold the legislation.

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