What's Going on in the Courts with Health Care Reform? Part One

In federal courts across the United States the federal Patient Protection and Affordable Care Act (ACA) is facing legal challenges by states, legislators, nonprofit organizations and private citizens. At issue in the more than 20 cases that have been filed in federal district courts is whether the ACA violates the Constitution. Why does this matter to you? Well, one big change provided for under this law is the elimination of pre-existing condition exclusions. As people living with the chronic health condition of migraines, the law will make it possible and more affordable for us to get insurance coverage.

Opponents argue specific parts of the law overstep the power of Congress to act in violation of the Constitution. Congress is only allowed to act within the authority it is specifically given in the Constitution. All other authority is retained by the states.

Individual Mandate - One of the challenges showing up in these cases relates to the law's requirement that every citizen obtain insurance. Failure to do so leads to a tax penalty.

The Constitution has been interpreted by the US Supreme Court to permit Congress a wide range of authority to regulate interstate commerce, including local issues that “substantially affect interstate commerce". The Court has upheld the ability of Congress to enact a number of laws governing individual conduct, such as the right to avoid interacting with racial minorities or to grow marijuana at home for personal use. However, the Court has never ruled on the issue of whether Congress can require individuals to purchase a product or service.

Certain cases have brought Congress's authority to tax in the manner called for under the ACA into question. While most agree Congress has the Constitutional authority to collect taxes, opponents say the way this tax is applied violates the 16th Amendment because it is not subject to apportionment (distributed fairly among the states). The Justice Department argues the tax is not subject to apportionment because it is an excise (indirect) tax, not a direct tax. Further, one judge has ruled the fee in question is a penalty, rather than a tax, therefore it's constitutionality is governed by the Commerce Clause, not Congress's taxing authority.

Another issue related to this provision involves the notion that the ACA's individual mandate violates the First Amendment's free exercise clause by funding abortion procedures against their beliefs or by requiring religious communities that believe in healing themselves to participate in the mainstream health care system. In a case filed by the private Christian school Liberty University a federal district judge ruled that the ACA does not require any plan to fund any kind of abortion service or procedure. The judge also noted the Executive Order issued after the law was enacted that specifically separates abortion-related funds.

This is part one of a series of two articles on legal issues being raised regarding the Affordable Care Act. In part two I will discuss the three other big issues (insurance market reforms, minimum employer contribution and Medicaid expansion) in greater detail.

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