Basically this argument is that citizens can't be required to participate in a market. They have to have the right to not participate if they choose to do so for economic reasons. Like nearly all conservative arguments this sounds moderately reasonable as long as you stay inside the frame that it is presented in. When you are just looking at the individual there may be a hardship in being required to purchase insurance. It is not going to be cheap and the subsidies are not going to cover everyone.
Given those facts it is easy to see how this might be considered an overreach of federal law making power. However it leaves out the reason for the mandate. Everyone, even the Great Orange John Boehner likes the idea of ending denial of coverage for pre-existing conditions. However when you do that, there is a real chance that people will wait until they are ill before getting coverage. This means that they will not be paying into the system while they are relatively healthy but instead come in when they are sick and expensive.
To allow this would shift the burden of cost of their treatment to those who do have coverage before a major illness. This would drive up the cost over all. So there needs to be a requirement for everyone to have insurance. Which is what the individual mandate is all about, it is expected by Congress that by having all citizens insured, there will be a long term reduction in the cost of health insurance. Given the constantly rising cost of insurance in the last two decades and the consequent rise in uninsured people, Congress found that there was a crisis which encompasses the entire nation.
Judge Steeh looked at the plaintiffs argument that there was no power for the Government to regulate personal activity and found that:
There is a rational basis to conclude that, in the aggregate, decisions to forego insurance coverage in preference to attempting to pay for health care out of pocket drive up the cost of insurance. The costs of caring for the uninsured who prove unable to pay are shifted to health care providers, to the insured population in the form of higher premiums, to governments, and to taxpayers. The decision whether to purchase insurance or to attempt to pay for health care out of pocket, is plainly economic. These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers, and the insured population who ultimately pay for the care provided to those who go without insurance. These are the economic effects addressed by Congress in enacting the Act and the minimum coverage provision.
The health care market is unlike other markets. No one can guarantee his or her health, or ensure that he or she will never participate in the health care market. Indeed, the opposite is nearly always true. The question is how participants in the health care market pay for medical expenses - through insurance, or through an attempt to pay out of pocket with a backstop of uncompensated care funded by third parties. This phenomenon of cost shifting is what makes the health care market unique.
Basically Judge Steeh did not take the bait to look at this from the point of the individual where the Governments power to regulate is weak, but correctly looked at it from the national situation. He finds that there is plenty of power for the Congress to regulate a market where individual decisions might disrupt the functioning of the market.
The TMLC also made arguments about the penalty being an illegal direct tax. Judge Steeh gave them a good dope slap on that one too:
The constitutional limits on taxes argued by plaintiffs relate to taxation generally for the purposes of raising revenue. While these might be legitimate concerns if Congress had to rely on its power conferred by the General Welfare Clause, such is not the case with regard to penalties imposed incidentally under the Commerce Clause. Id. In this case, the minimum coverage provision of the Health Care Reform Act contains two provisions aimed at the same goal. Congress intended to increase the number of insureds and decrease the cost of health insurance by requiring individuals to maintain minimum essential coverage or face a penalty for failing to do so. Because the "penalty" is incidental to these purposes, plaintiffs' challenge to the constitutionality of the penalty as an improperly apportioned direct tax is without merit.
In the end he denied all the claims the TMLC made and dismissed their case.
This is a good sign for all the other cases brought against the ACA on Constitutional grounds. The Judge did not have to make any finding of fact and the standard for finding it constitutional is the "rational basis". This standard does not require that Congress be correct that the ACA will lower cots, only that it is rational in its reasons for trying to do so and its assumptions in crafting the Act. Since the assumptions are not challenged by the suits there is little chance that even the most radically conservative judge will be able to find that Congress can not make laws where are essential to the regulation of an existing market. This includes requiring citizens to buy insurance or pay a penalty on their taxes as a result.
It will probably not stop the other law suits form going forward. After all they were mostly political stunts. However it does take a lot of the steam out of the sails of the wackos to have the very first case so decisively decided against them.
The floor is yours. |
