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Individual mandate constitutional via Congress' power to tax

Commerce Clause deemed irrelevant; taxing authority key

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WASHINGTON—The core of the Republican state attorneys' general argument on why the individual mandate was unconstitutional was that Congress lacked the legal authority under the U.S. Constitution's Commerce Clause to require the purchase of health insurance.

In upholding the mandate, Supreme Court Chief Justice John Roberts said the attorneys' general argument was not wrong, but irrelevant.

“The individual mandate cannot be upheld as an exercise of Congress' power under the Commerce Clause,” Justice Roberts wrote for the majority in the 5-4 decision on the Patient Protection and Affordable Care Act. “In this case, however, it is reasonable to construe what Congress has done is increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress' power to tax.”

“The federal government does not have the power to order people to buy health insurance. The federal government does have the power to impose a tax on those without health insurance,” Justice Roberts concluded.

The chief justice's comments on the individual mandate were among dozens made by the justices in analyzing the issues before them.

For example, Chief Justice Roberts explained why lawmakers thought an individual mandate was essential to avoid adverse selection. Without a mandate, individuals would wait until they were sick to buy health insurance, which would drive up premiums for everyone.

“The individual mandate was Congress' solution to these problems,” Justice Roberts said.

Other justices discussed the crucial role of health insurance.

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“Inescapably, we are all at peril of needing medical care without a moment's notice,” Associate Justice Ruth Bader Ginsburg wrote.

In coupling an individual mandate with a requirement that health insurers provide coverage to all buyers—regardless of their health status—federal lawmakers looked to Massachusetts, the state that did just that in its 2006 health care reform law, Justice Ginsburg wrote.

“In coupling the minimum coverage provision with guaranteed-issue and community rating prescriptions, Congress followed Massachusetts' lead,” Justice Ginsburg wrote. While, not everyone may approve of that policy decision, “It was Congress' prerogative to make it.”

But other justices, in their dissent, described the individual mandate as a grave overreach of congressional authority.

Referring to healthy individuals who choose not to purchase coverage, “If Congress can reach out and command even those furthest removed from the interstate market to participate in the market, then the Commerce Clause becomes a font of unlimited power,” Associate Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito wrote in their joint dissent.

The case before the high court was “easy and straightforward” in another way, the dissenters wrote.

“What is absolutely clear, affirmed by the text of the 1789 Constitution, by the 10th Amendment ratified in 1791, and by the innumerable cases of ours in the 200 years since, is that there are structural limits upon federal power—upon what it can prescribe with respect to private conduct,” the dissenters wrote.

While the Obama administration justified the mandate as a “straightforward exercise of government power” to regulate under the Commerce Clause because eventually nearly all individuals will purchase goods and services covered by insurance, that “definition of market participants is unprecedented, and were it to be a premise for the exercise of national power, it would have no principled limits,” the dissenters wrote.

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