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Health-Care Law Passes First Test in Courts

This post originally appeared at the Political Animal. No matter what happens in the midterm elections, opponents of the Affordable Care Act will struggle to repeal the law through legislative means. They're better off, at least marginally, taking their case to the courts, where there are currently over a dozen challenges to various provisions of the health care law, most notably the individual mandate. There were a couple of procedural rulings over the summer, but none dealt with the law on the merits. That changed yesterday, when a federal judge found the law constitutional, ruling that the mandate is legal through the Commerce Clause.
Judge George C. Steeh of Federal District Court in Detroit ruled that choosing not to obtain insurance qualified as an example of "activities that substantially affect interstate commerce." That is the standard set by the Supreme Court for Congress's compliance with the Commerce Clause. Judge Steeh, who was appointed by President Bill Clinton, agreed with the federal government that not obtaining health coverage is effectively an active decision to pay for medical care out of pocket. "These decisions, viewed in the aggregate," Judge Steeh wrote, "have clear and direct impacts on health care providers, taxpayers and the insured population who ultimately pay for the care provided to those who go without insurance."
The case was brought by a conservative legal outfit called the Thomas More Law Center, which insisted the public couldn't be compelled to purchase insurance. The Justice Department responded, pointing not only to the Constitution's Commerce Clause, but also to the "congressional power to tax and spend to provide for the general welfare." Judge Steeh agreed with the Obama administration on both. Jonathan Cohn added that the ruling is "pretty much a wholesale win for reform," and that "the future of health care reform just became a little more secure."
[T]he premise of Steeh's legal argument seems to be a notion about policy -- that it's not possible to regulate the insurance industry, in a way that would make coverage available to all people, without compelling every person to get coverage. On that count, I would argue, Steeh is correct. So what does this mean for the repeal movement? My limited understanding, informed by a few casual conversations with some law professors, is that Steeh's decision is consistent with the traditional understanding of the Commerce Clause -- that the only way to throw out the mandate would be to reexamine conventional assumptions about the Commerce Clause. That would be a fairly radical move.
That's the good news. There are, however, plenty of rulings yet to come, and yesterday's decision will be appealed to the 6th Circuit, which is one of the nation's most conservative and might be inclined to make a "fairly radical move." Still, yesterday was a heartening win, and will likely be the first of many.
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