Constitutionality of the Affordable Care Act's individual mandate

Sky v. Holder

Susan Seven-Sky v. Eric H. Holder, 661 F.3d 1 (2011).

Facts

The Appellants in the case are four United States citizens and taxpayers who are seeking a declaratory and injunctive relief to prevent the enforcement of the minimum essential coverage provision of the Affordable Care Act. The minimum essential coverage provision of said Act requires all U.S. citizens to purchase and maintain certain minimal levels of health insurance coverage beginning in calendar year 2014 or face sanctions. On the trial level, the U.S. District Court dismissed the Appellant's request by granting the government's Motion to Dismiss. The substance of the District Court's ruling was that the U.S. Congress had authority under the Commerce Clause and the Necessary and Proper Clause. The Court ruled that Congress had the power and authority to regulate any activity that substantially affects the health insurance and health care market place and that such industry is a proper subject for regulatory legislation. On appeal to the D.C. Circuit, a divided Court affirmed the District Court's ruling on the merits. A dissent was filed by Judge Kavanaugh on the issue of subject matter jurisdiction only.

3. Issue

Whether the D.C. Circuit federal court possesses subject matter jurisdiction regarding a case involving the Affordable Care Act in light of the Anti-Injunction Act and, if so, whether the individual mandate provisions of the Affordable Care Act is a constitutional exercise of the authority granted the U.S. Congress under the Commerce Clause of the U.S. Constitution.

4. Holding

The District Court ruled that Congress had the power and authority to regulate any activity that substantially affects the health insurance and health care market place and that such industry is a proper subject for regulatory legislation and that, therefore, the mandates of the Affordable Care Act are a proper exercise of the power of the U.S. Congress. On appeal the D.C. Circuit Court affirmed the District Court's ruling on the merits.

6. Application to health care administration

The significance of the Sky case is the fact that the D.C. Circuit Court categorically found that the U.S. Constitution's Commerce Clause is applicable to the situation in which the impact of millions of uninsured and underinsured affects interstate commerce and that such situation overrides the concerns of any given individual who may choose to be uninsured. The primary argument of the Appellants and that of most opponents of the Affordable Care Act was that Congress did not have the authority to require individuals with no connection to interstate commerce to purchase a product. The D.C. Circuit in rendering its decision recognizes that, in isolation, an individual may assert his right not to purchase health insurance but that such individual, in time, will require health services. No one can truly live without eventually requiring some form of medical care and that Congress, in issuing its health insurance mandate, recognized that those who do not have health insurance and, instead choose to be self-insured, will inevitably receive health services for which they cannot pay. The practical effect of this occurrence is that these uncovered costs are shifted to those who are insured and that this, in turn, results in increased health insurance costs for everyone.

The Court's ruling in Key is a further expansion of the rationale first recognized in the Wickard v. Filburn case (Bogen, 1972). The Court expressed an appreciation for the fact that individuals should have the right to act in isolation but that in the case of health care and health insurance there really is no such thing as acting in isolation. Everyone will eventually require health care and it should not be the responsibility of the general public to absorb these costs at the expensive of protecting the exercise of individual liberty. In the case of health care, the cost of personal liberty is too expensive and, in the opinion of the D.C. Circuit Court, Congress has the right to act so that the uninsured do not create market failures.

The Sky case, at least for the moment, signals a major victory for the Obama administration and a major step forward in the implementation of the Affordable Care Act. The D.C. Court, in rendering its decision, recognized the various arguments being offered by opponents to the Affordable Care Act but minimized each of them (Manchikanti, 2011). The Court argued that although requiring the purchase of health insurance was an encroachment upon individual liberties such encroachment was no more grievous than requiring hotels and restaurants to serve all customers regardless of race, "… is no more so than a command that restaurants or hotels are obliged to serve all customers regardless of race, that gravely ill individuals cannot use a substance their doctors described as the only effective palliative for excruciating pain or that a farmer cannot grow enough wheat to feed his family. The right to be free from federal regulation is not absolute, and yields to the imperative that Congress is free to forge national solutions to national problems (Key v. Holder, 2011: pp.36-37)."

Although the D.C. Circuit Court's decision is not binding on the remainder of the nation it is considered by many legal experts to be a good harbinger of things to come when the U.S. Supreme Court rules on the constitutionality of the Affordable Care Act this coming fall (Liptak, 2011). The reasoning of the Key Court is considered to be well organized and clearly set forth and incorporates the thinking of some of the more conservative Supreme Court justices whose views will be crucial in the decision making process utilized said Court. If the Supreme Court determines to follow the reasoning set forth in KeyKey, the entire bulk of the Affordable Care Act will likely soon become the law of the land ushering in an entire new era in health care and health insurance in the United States.