The legal battle over the federal healthcare reform law boils down to an argument over how to balance two opposing principles within the Constitution: the broad power granted to Congress to regulate interstate commerce, and the liberties reserved to individual citizens. In a series of decisions over the past century, the Supreme Court has relaxed the limits on Washington's power over commerce, leading some conservatives and libertarians to fear that Congress could interfere in just about any decision made by businesses and their customers.
FOR THE RECORD: Individual mandate: A Dec. 15 editorial on the healthcare reform law's rule that individuals buy insurance said that Christian Scientists are exempted. They are not. —
To these critics, the Patient Protection and Affordable Care Act's requirement that adults obtain health insurance represents a new milestone in congressional overreach. And on Monday, District Judge Henry E. Hudson in Richmond, Va., gave them their first courtroom victory. According to Hudson's ruling, the so-called individual mandate is unconstitutional because Congress' power to regulate a market extends only to people who choose to participate in that market. The Constitution's commerce clause doesn't give Congress the power to force people to buy something against their will.
That may be a fine boundary to set for lawmakers. But contrary to Hudson's pinched view of the individual mandate, Congress did not cross that line in the Affordable Care Act. That's because the mandate isn't merely an attempt to regulate the purchase of insurance. It's a vital part of a larger scheme to overhaul the healthcare industry, including the way medical services are delivered and paid for.
There's no question that healthcare is a form of interstate commerce subject to regulation by Congress. Nor is there any question that the adults subject to the individual mandate participate in that market, whether it be buying aspirin at a drugstore, visiting a doctor for a checkup or rushing to an emergency room for treatment. (The law exempts Christian Scientists and others who abstain from medical care for religious reasons.) The individual mandate affects how people pay for the care they consume, but it doesn't force them into the healthcare market — they're already there.