Constitutionality of the Individual Mandate

Patient Protection and Affordable Care Act (PPACA) One of the most significant recent U.S. Supreme Court decisions was the Court's validation of the PPACA's individual mandate, requiring virtually all Americans (with some exceptions) to purchase health insurance. The individual mandate was a critical component of the ability of the Act to function as it was designed by legislators.

It was essential that people who were relatively healthy and young were insured to expand the risk pool of the insured given that preexisting conditions were no longer allowed to be grounds for denying people health insurance. This ensured that people would not simply wait until they were sick to seek out insurance.

However, it is worth noting that there were numerous exceptions to this provision, including "undocumented immigrants, religious objectors, and people who are incarcerated" and those for whom paying the penalty for being non-insured would cause a financial hardship (Musumeci 2012: 2). The Act also expanded Medicaid, the state-run, federally-subsidized healthcare program for those living in poverty.

The "ACA expands the Medicaid program's mandatory coverage groups by requiring that participating states cover nearly all people under age 65 with household incomes at or below 133% FPL ($14,856 per year for an individual and $30,657 per year for a family of four in 2012)" (Musumeci 2012: 3).

While the individual mandate and the Medicaid expansion were the two critical provisions on which the Act was challenged when it was brought forth to the Supreme Court, the majority of the court (including Chief Justice Roberts) "held that the individual mandate is a constitutional exercise of Congress' power to levy taxes, given that the Constitution states that "Congress shall have Power. To lay and collect Taxes, Duties, Imposts and Excises, to say the Debts and provide for the common Defense and general Welfare of the United States" (Musumeci 2012: 4).

It was noted that this was something of a surprise, given that the federal government, in its support of the ACA, did not claim that the penalty levied for being uninsured was a tax. However, the Court decided that the individual mandate effectively functioned as such, given that the amount of the fine was less than the price of insurance and could not be more, based upon the Act's provisions (Musumeci 2012: 4). The dissenting minority viewed the individual mandate instead as a shared responsibility payment, which it stated was indeed unconstitutional.

However, the penalty was imposed solely by the IRS and collected like a tax even though its purpose was not to raise revenue and was labeled a "penalty" by the federal government (Cole 2012). It should be noted that before the decision was handed down, an online statement by 100 prominent law professors was issued supporting the constitutionality of the individual mandate.

They stated their belief that it fell within the provisions of Congress to regulate interstate commerce and that the fact that healthcare-related issues could not be solved by the actions of a single state alone was just the sort of problem Congress had been given the power to address through the interstate commerce clause ("Over 100," 2012). However, the Court disregarded this argument and instead supported the notion of the individual mandate as a tax.

The Commerce Clause was rejected as supporting the provisions of the ACA because it could be read as giving Congress the right to compel people to engage in commerce and "the court ruled that Congress can regulate existing interstate commercial activity, but it can't directly force people to enter into a market (by, say, requiring them to purchase health insurance)" (Plumer 2012).

In addition to its ruling on the individual mandate, "the Court ultimately held that the Medicaid expansion is unconstitutionally coercive of states because states did not have adequate notice to voluntarily consent, and the Secretary could withhold all existing Medicaid funds for state non-compliance" (Musumeci 2012: 5).

However, while the Court found the Medicaid expansion to be technically not in compliance of the Constitution, it decided that it was within its power to provide a redress and remedy, which it did: "the Roberts group concludes that restraining the Secretary from withholding a state's existing Medicaid funding for failure to comply with the Medicaid expansion "fully remedies the constitutional violation" (Musumeci 2012:5). Given Chief Justice Roberts' appointment by a Republican, conservative president, many were surprised by his upholding of the ACA.

However, it would have been a dramatic precedent in and of itself to have overturned such a sweeping act of congressional legislation as unconstitutional. "In part, the outcome reflects the fact that the truly radical position in this dispute was that of the challengers. Even very conservative lower court judges, including Jeffrey Sutton of the.