Health Care Suits: Separating Law From Spin

If a public figure walks on water at noon, by 3 p.m. a dozen talking heads will be explaining that he can't swim.

That's politics. But we can hope that federal judges won't think in sound bites.


The current lawsuits challenging the Affordable Care Act raise this question insistently. I return to this lawsuit in yet another column because I believe this case will dominate both constitutional law and political discourse over at least the next 12 months--and because I believe its stakes far transcend its immediate consequences, important though they will be. I think that if our federal courts are willing to sign on to the challengers' jejune theory of this case, not only we but our children will spend years dealing the malign consequences of the mistake. Nothing less than the ability of the United States to function as a modern nation may be at stake.

(Okay, I also return because I enjoy the comments that will shortly appear below accusing me of being Kim Jong Il, but that's a secondary reason.)

So far, in two of the pending lawsuits, opponents of the law have succeeded in spinning the judges, framing the lawsuits as posing the question whether (as Virginia argued) the federal government can "impose a penalty for what amounts to passive inactivity."

We know the talk-radio answer to this question: Tyranny! Death panels! Black helicopters! Praise the Lord and pass the ammunition!

But the judicial answer, it seems to me, should be two-fold.

The first, and most important, answer a judge should give is, "I dunno. Find a case where the government does that and get back to me." Because that description of the Affordable Care Act is simply inaccurate.

The second answer, which a judge shouldn't give but a Con Law jock like me can, is, "Why ever not?"

I will get to that one later; but first, let's deal with the canard that the Act somehow "penalizes inactivity."

Here's how Judge Henry Hudson put it in his decision in Cuccinelli v. Sebelius: The Act "requires that every United States citizen, other than those falling within specified exceptions, maintain a minimum level of health insurance."

This snappy apothegm is the logical equivalent of saying that the Defense Appropriations Act "requires that every United States citizen, other than those who leave the country, engage in accepting a minimum level of protection by the United States military." The provisions of the Health Care Act provide a benefit. The majority of Americans, who already have health coverage (and seem, by and large, to regard this coverage as worth bargaining for) will simply see improvements in their existing health care benefits, such as an end to lifetime benefit limits and the right to include older adult children on their policies. A significant number of others who are currently uninsured will become eligible for government-funded health insurance.

There will remain a small but significant number of Americans who can afford health care insurance but choose not to buy it. But contrary to the sound bite above, even they are not required to "maintain a minimum level of health insurance." If they wish to keep their uninsured status, they may do so by paying an addition to their income tax bills--ranging from as little as $695 for an individual taxpayer to $2085 for a family of six or more. The claim that the government is "forcing individuals to buy a commercial product" is worse than spin; it is simply false.

In fact, even the choice of procuring insurance or paying a tax is put not to "every United States citizen," or even "every United States citizen not already covered by insurance," but only to those who earn enough income to qualify as taxpayers. "A small fraction of fewer than half of United States citizens," though accurate, is much less thrilling to say, even for a judge, than "every citizen."

This brings us to the contention that the act somehow regulates "inactivity." Let's you and I test this proposition: why don't you just remain totally inactive in 2014, when the Act first takes effect.

Quit your job and get rid of your investments. The government will not regulate you. (True, it may offer you government-financed health care; but again, that is a benefit, not a regulation or punishment.)

But if you decide actually to work (I recommend that, by the way), you are not being "inactive." You are taking part in commerce. The Constitution gives Congress plenary authority "to regulate commerce with foreign nations, and among the several States, and with the Indian Tribes."

A system of regulation might easily include requiring you to pay taxes if you choose to burden commerce; willful refusal to maintain adequate health coverage for yourself and your family is such a burden. To claim otherwise doesn't pass the straight-face test.

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Garrett Epps is a contributing writer for The Atlantic. He teaches constitutional law and creative writing for law students at the University of Baltimore. His latest book is American Justice 2014: Nine Clashing Visions on the Supreme Court.

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