Defending the Affordable Care Act

Merrill Goozner

Posted 3/14/12 on Gooz News

What will they do? The Supreme Court (more or less) that gave us Bush v Gore in 2000 will later this month hear arguments by states challenging the Affordable Care Act, a.k.a. health care reform. The heart of the legal challenge raised by conservative state attorneys general is whether the individual mandate is constitutional. What happens if the Supremes say no? Does the entire law fall, or just the mandate?

The issue for lawyers is called “severability.” Did Congress when passing the law believe the mandate was necessary to the smooth functioning of the rest of the law? Clearly there are large swaths of the law for which the mandate is largely irrelevant: the physician payments sunshine act (disclosure of drug company payments to doctors); the creation of the Patient Centered Outcomes Research Institute to conduct comparative effectiveness research; the numerous payment pilot projects; and more.

But on the core question of the law’s desire to expand coverage for the uninsured and set minimum insurance standards like forcing insurance companies to guarantee policies to all comers at non-discriminatory rates, the issue of the mandate’s necessity becomes murkier. The Obama administration is simultaneously arguing that it is crucial to the law’s smooth functioning, yet isn’t necessary. How can both be true? Here’s how two physicians, Samuel Y. Sessions and Allan S. Detsky, writing in the New England Journal of Medicine explain the seeming contradiction:

Arguing that the mandate is constitutional under the Commerce Clause requires taking the position that it is “essential” to the statutory scheme, whereas arguing that it is severable dictates the seemingly opposite position that the ACA is “capable of functioning without it.” Politically, making both arguments may be awkward, which may be one reason why the administration endorses partial severability. Legally, however, the positions are consistent: the mandate may be an important part of the statutory scheme, and thus constitutional, but not absolutely vital, and hence completely severable.

Important, but not vital. If the Supreme Court strikes down the mandate but leaves the rest of the law intact, the insurance industry will have to jack up rates to pay for the free riders who fail to purchase coverage. That would be sad. But let’s not forget that it would be no different than what we have now with regard to the free-riding problem, while we would still have millions more with coverage.

3 thoughts on “Defending the Affordable Care Act

  1. The e court has had 4 new justices since 2000; hardly the same.

    But what would actually be sad is that the Democratic congress rammed through an unconstitutional law in a disgracefull manner. Trampling the constitution in such a way is a jolt to the principles and values this country was founded upon.

  2. Newer and more explicitly written constitutions include healthcare as a right. I realize that the ambiguity of our constitution results in opinions such as yours that anything which doesn’t seem to hue to the original words must be a trampling of the document itself. However, I do not believe the constitution is quite that b&w. This is why this issue is now before the courts.

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