Is the Individual Health Insurance Mandate Constitutional?

Abstract

The Supreme Court is about to hear a case of great legal and political importance. At issue is the constitutionality of the so-called “individual mandate” in the Patient Protection and Affordable Care Act, which requires most Americans to purchase health insurance starting in 2014 or pay a monetary penalty.The question is whether Congress exceeded its Constitutional power to regulate “Commerce...among the several States” (i.e., regulate interstate commerce) and to make laws “necessary and proper” to carry into effect that power. It’s unlikely the Obama Administration can justify the individual mandate as a regulation of interstate commerce. How can the failure to purchase health insurance in itself be considered commerce, let alone interstate commerce? If that is interstate commerce, what can’t Congress force us to purchase? For that reason, the outcome of the case will likely turn on whether the individual mandate is both “necessary” and “proper” to carry into effect Congress’s power to regulate interstate commerce. To succeed on the “necessary” test, the Obama Administration must make constitutional arguments that don’t have any logical limits and therefore give Congress vast powers over our lives, and this undermines its ability to show that the individual mandate also meets the “proper” test, which requires that it be consistent with “the letter and spirit of the constitution.”On its face, the individual mandate fails the "proper" test. It abandons the long-standing legal principle that legally binding contracts require mutual assent and cannot be coerced. This crosses a line the federal government has never crossed and effectively tramples on “The powers...reserved...to the people” under the Tenth Amendment. It is inconsistent with the fundamental concept of self-ownership that underlies the theory of natural rights in the Declaration of Independence - the idea that we own ourselves and, therefore, have the right to be left alone as long as we honor the equal right of others to be left alone.Beyond that, the Administration’s expansive view of the commerce power creates a sea of federal power limited only by islands of individual rights (and limits on using the commerce power to regulate non-economic activity), and that is inconsistent with the letter and spirit of the Constitution: It imposes virtually the same limits on federal and state power and, therefore, effectively gives the federal government the same “police powers” as the states. It puts liberty at risk by relying entirely on individual rights to protect us against things like mandated doctor visits and exercise. For example, the Supreme Court has found an unenumerated “right to liberty” only where there is no harm to others. The courts could easily decide that skipping annual physicals or living a sedentary life harms others by raising medical costs for some and insurance premiums for all. The Administration makes the following arguments to allay concerns about the threat to liberty its theories pose, but those arguments don’t stand up to scrutiny: The government imposes the equivalent of mandates all the time. Economic mandates are no more intrusive than regulations or prohibitions of chosen activity. Congress can use its taxing power to achieve the same ends, so using the commerce power is permitted. We can rely on the political process to protect our liberty.