A federal judge is hearing arguments that health care reform violates the constitution. In particular, states are challenging the requirement for individuals to buy health insurance. How key is this requirement for the entire law? How nervous should reformers be?
Let's step back. You can think about the health care overhaul signed by President Obama this year like a three-legged stool supporting universal quality health care. The law (1) requires everybody to buy care to spread costs, (2) prohibits insurance companies from denying sick customers and (3) gives money to folks who can't afford insurance. Without the first leg, insurance companies would jack up premiums even higher. Without the second leg, insurance companies could continue to deny coverage. Without the third leg, families could go bankrupt from being forced to spend too much on insurance.
That's why the legal case against Leg One, the universal insurance requirement, is important. Currently the law says that if you don't buy health insurance, the government will fine you. The legal challenge against that penalty falls under the Commerce Clause, which allows the federal government to make laws that impact inter-state commerce. Health care is almost surely "inter-state," since Americans move between states all the time. But is not buying health care a commercial activity, or is it, by definition, inactivity?