Will the Court Throw Out Obamacare?

Last Monday, the Supreme Court announced something that’s been obvious for a while now: It will rule on the constitutionality of the Patient Protection and Affordable Care Act, nicknamed the ACA or Obamacare. This was inevitable, because four appeals courts have ruled on the Act and disagreed: three said it was constitutional, and one said not. Since a federal law can’t be constitutional in some parts of the country but not others, the Supreme Court needs to straighten this out.

The rulings so far. At the district court level, rulings tended to be political: Judges appointed by Republican presidents invalidated the law while those appointed by Democrats upheld it. (The most polemic invalidation was Reagan appointee Judge Roger Vinson’s in the Pensacola District.) Fortunately, the appellate courts were more, well, judicious in their rulings. In particular, the D. C. appeals court ruling two weeks ago gives a good model of the two most likely ways the Supreme Court might go.

Like the Supremes, the D.C. court had a conservative majority: a Reagan appointee (Laurence Silberman), a Bush II appointee (Brett Kavanaugh), and a Carter appointee (Harry Edwards). Both the majority opinion and the dissent were written by the conservatives.

The majority opinion (by Silberman, supported by Edwards) upheld the constitutionality of the ACA. The dissent (Kavanaugh) didn’t rule on the constitutional issues, saying that the courts could not intervene until the law has fully taken effect in 2014.

Both opinions are well thought out, and I believe the Supreme Court will back one or the other of them.

The issues. The controversial part of the ACA is the individual mandate: It requires people to buy health insurance and penalizes them if they don’t. This notion was proposed by the conservative Heritage Foundation in the 1990s as an alternative to Medicare-like proposals for universal health care, because it keeps the health insurance industry private. Newt Gingrich supported the mandate then, and Mitt Romney made it the center of his Massachusetts healthcare plan.

Now, however, conservatives claim it is unconstitutional for this reason: Article I, Section 8 of the Constitution lists the powers of the federal government, and conservatives hold that none of those powers can be stretched to cover the individual mandate.

Supporters of the law claim that it is authorized by Section 8’s Commerce Clause

Congress shall have Power… To regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes

plus the Necessary and Proper Clause

Congress shall have Power … To make all Laws which shall be necessary and proper for carrying into Execution the foregoing powers

In other words, Congress can regulate the interstate market in health care, and in carrying out that mission, Congress has found it necessary and proper to mandate that people buy health insurance.

It’s not a tax. The annoying thing about this whole debate is that Congress could have avoided it by wording the law differently. If it had called the mandate a tax instead of a penalty (in other words, we’re going to tax people who don’t have insurance) it would have fallen under the sweeping power to tax that Section 8 gives Congress:

The Congress shall have Power to lay and collect Taxes

One reason Judge Kavanaugh gives for delaying a ruling until after 2014 is that in the meantime Congress could make the whole issue moot with this minor rewrite of the law.

The who-pays-what-to-whom would be identical. The difference is purely moral: Under the ACA as it stands, an uninsured person is breaking the law, for which s/he is assessed a penalty (collectable by the IRS on the income tax form). If the mandate were a tax, an uninsured person could obey the law by paying the tax (in the same amount on the same form).

The administration has argued that this makes no practical difference, so the courts should rule the ACA constitutional under the taxing power. But judges aren’t buying it. Who’d have suspected: You can’t tell a judge that it makes no difference whether a person obeys or breaks the law.

Or maybe it is a tax. The main reason not to rule on the ACA until 2014 is the Anti-Injunction Act, which says that a judge can’t issue an injunction to prevent a tax from going into effect. If a tax is invalid for some reason, the proper process is for the government to begin collecting the tax and for the courts to get involved only after people to sue to get their money back.

The point, I think, is to keep one or two renegade judges from screwing up the whole government by shutting off its revenue.

I know what you’re thinking: If the mandate is a penalty and not a tax, what does the Anti-Injunction Act have to do with it? Well, apparently there’s a penumbra of some sort, so that if a non-tax is sufficiently tax-like, the Act applies. (You can tell from the D.C. court ruling that Silberman and Kavanaugh had a long argument about this. I confess to skimming this part of their opinions.)

Action vs. inaction. Sooner or later, though, either now or after it takes effect in 2014, the Court is going to have to rule on whether the Commerce Clause authorizes the individual mandate.

Anyone who wants to invalidate the ACA has to deal with the long history of courts interpreting the Commerce Clause loosely and expansively. Under current precedents, Congress can regulate economic activity within a state if that activity is part of a larger interstate market, and it can even regulate non-economic activity (like limiting the quantity of wheat that a farmer can grow for his own use) if some larger scheme of economic regulation depends on it. Commerce-clause justifications have only been rejected when the obvious intention of the law was to regulate local, non-economic activity (like keeping guns away from schools) on the vague justification that the activity has some eventual impact on interstate commerce.

So the basic commerce-clause justification of the ACA goes like this: Healthcare is an interstate market, so Congress has a legitimate interest in regulating it. The scheme implemented in the ACA is a legitimate attempt to regulate that market. That scheme falls apart without the individual mandate, so the mandate is necessary and proper to carry out Congress’ commerce-regulating power.

The counter-argument is that none of the precedents cover the ACA’s individual mandate, because they all concern some kind of activity, while the mandate is regulating inactivity. Simply by existing, the ACA claims, you affect the interstate healthcare market. So upholding the ACA is breaking new ground and substantially expanding the power of the government. If the ACA is upheld, what couldn’t Congress force people to do?

Judge Silberman’s ruling. Silberman agrees with the counter-argument up to a point, but not all the way to its conclusion. The precedents don’t cover inactivity, but the whole activity/inactivity distinction is itself new. It’s not in the Constitution, and it’s not implied by the precedents. So it’s not exactly conservative to toss the law out on these novel grounds.

What’s more, he rejects the basic conservative frame that the mandate is an individual-liberty issue:

Appellants’ view that an individual cannot be subject to Commerce Clause regulation absent voluntary, affirmative acts that enter him or her into, or affect, the interstate market expresses a concern for individual liberty that seems more redolent of Due Process Clause arguments. But it has no foundation in the Commerce Clause.

… it is irrelevant that an indeterminate number of healthy, uninsured persons will never consume health care, and will therefore never affect the interstate market. Broad regulation is an inherent feature of Congress’s constitutional authority in this area; to regulate complex, nationwide economic problems is to necessarily deal in generalities. Congress reasonably determined that as a class, the uninsured create market failures; thus, the lack of harm attributable to any particular uninsured individual, like their lack of overt participation in a market, is of no consequence.

Silberman finds no obvious place to limit Congress’ Commerce Clause power here, but notes that Congress is subject to a “political check”. In other words: This is one of many areas where Congress has the constitutional power to do all kinds of crazy things, and it’s up to the voters to see that they don’t. If Congress only had the power to do wise things, we wouldn’t need to have elections.

What will the Supreme Court do? I think that Silberman and Kavanaugh have blazed the two possible paths that an honest conservative judge can follow: Unless you want to invent some new restriction that isn’t in either the Constitution or the case law, you have to find the ACA constitutional. Your only other option is to punt the ball to 2014 or 2015 by invoking the Anti-Injunction Act.

Now, the Roberts Court has shown itself to be political. Its maneuvering around Citizens United, where it made a ruling more sweeping than either side was asking for, is a case in point. In that vein, I find it disturbing that the Court has chosen to review not just the individual mandate of the ACA, but also its Medicaid expansion, which none of the appellate courts had a problem with. That hints at another activist ruling, where the Court answers a question no one is asking.

Still, Silberman’s reasoning will be hard to reverse, particularly since his opinion quotes both Roberts and Scalia. So I believe the Court will take either the Silberman or the Kavanaugh route.

But the choice between them will be based on politics, not law. The Court’s decision, which may not come out until June, will frame the healthcare issue for the fall election. (Kavanaugh already hints at this by suggesting that a future president could decide not to enforce the mandate if he believes it to be unconstitutional.)

The decision will be determined by the Republicans’ electoral prospects: Will it be better for them to have the issue hanging, or to know that the ACA will take effect unless a new Congress reverses it or a new president refuses to enforce it?

So I’m taking the moderately cynical view of the Roberts Court. I don’t think they’ll throw the ACA out just because they dislike it politically, but which of the valid legal options they’ll take will be determined by politics.

Post a comment or leave a trackback: Trackback URL.


  • Kim Cooper  On November 27, 2011 at 3:33 am

    Trackbacks shouldn’t be counted as comments: it’s really annoying to tell my computer to get the comments and then find there aren’t really any comments. Or, am I just annoyed because my computer is old and slow?

    • weeklysift  On November 28, 2011 at 10:22 am

      I think this is a general WordPress decision that is beyond my power to change.


  • By Refraining From Violence « The Weekly Sift on November 21, 2011 at 1:18 pm

    […] Will the Court Throw Out Obamacare? The Supremes will rule on the Affordable Care Act’s constitutionality sometime between now and June. Two conservative appellate judges just gave us a preview of what they might do. […]

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