Sixth Circuit Upholds Constitutionality of Health Care Law

stethoscope and flag4.JPGFinding that Congress properly exercised its legislative power under the Constitution’s Commerce Clause in enacting the Affordable Care Act’s minimum coverage provision – commonly referred to as the Act’s “individual mandate” to purchase health insurance – the U.S. Court of Appeals for the Sixth Circuit affirmed a lower court’s determination that the health care law is constitutional. The Sixth Circuit’s decision in Thomas More Law Center v. Barack Hussein Obama (pdf) represents the first ruling by a federal circuit court of appeals on the health care law’s constitutionality. Although there are more than 25 lawsuits pending across the country seeking to invalidate the health care law, so far only five have reached the federal appellate level. The fourth, ninth, eleventh, and D.C. Circuit Courts of Appeal are similarly in the process of reviewing health law challenges. It is likely that the opinions across the circuits will vary, forming the basis for ultimate Supreme Court review.

The plaintiffs in the instant case – the Thomas More Law Center, which is a public interest law firm, and four individuals – claimed that Congress overreached its authority in requiring individuals to purchase minimal essential coverage or pay a fee. In drafting the Affordable Care Act, Congress justified the “pay or play” requirement as “essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.” Among other things, the Constitution’s Commerce Clause grants Congress the power to regulate activities that substantially affect interstate commerce. In upholding the legality of the Affordable Care Act’s pay-or-play provision, Sixth Circuit Judge Boyce Martin, Jr. reasoned:

By regulating the practice of self-insuring for the cost of health care delivery, the minimum coverage provision is facially constitutional under the Commerce Clause for two independent reasons. First, the provision regulates economic activity that Congress had a rational basis to believe has substantial effects on interstate commerce. In addition, Congress had a rational basis to believe that the provision was essential to its larger economic scheme reforming the interstate markets in health care and health insurance.

The plaintiffs also alleged that the minimal coverage provision was not properly enacted under the Commerce Clause because it regulates inactivity. In dismissing this argument, the Judge Martin explained that “the text of the Commerce Clause does not acknowledge a constitutional distinction between activity and inactivity, and neither does the Supreme Court. Furthermore, far from regulating inactivity, the provision regulates active participation in the health care market.”

Because the court found that Congress did not exceed its authority under the Commerce Clause, it declined to address whether the individual mandate is authorized by the Constitution’s General Welfare Clause.

It is notable that all three judges comprising the 6th Circuit panel issued separate opinions in this matter. Taking all three opinions together, it appears that the individual mandate was upheld in this case because the plaintiffs’ facial challenge was too broad. As discussed in Judge Sutton’s concurring opinion, facial challenges seek “to leave nothing standing—to prevent any application of the law no matter the setting, no matter the circumstances.” Considering the facts of the case before the court, Judge Sutton reasoned that “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.” He suggested, however, that more specific challenges to the individual mandate as the law takes effect could succeed: “While future challenges to the law have hills to climb, nothing about this view of the case precludes individuals from bringing as-applied challenges to the mandate as the relevant agencies implement it . . .”

Judge Graham, on the other hand, had serious reservations about the constitutionality of the individual mandate. In his dissenting opinion he wrote: “If the exercise of power is allowed and the mandate upheld, it is difficult to see what the limits on Congress’s Commerce Clause authority would be.”

Photo credit: Feverpitch Photography

Information contained in this publication is intended for informational purposes only and does not constitute legal advice or opinion, nor is it a substitute for the professional judgment of an attorney.