[Cross-posted from Angry Bear, with minor editing.]
I’ve written repeatedly at Angry Bear during the last year or so that the challenge to the constitutionality of the ACA’s minimum-coverage provision (a.k.a., the individual-mandate provision) is not really a Commerce Clause challenge but instead a challenge under the Fifth Amendment’s due process clause, under what is known as the “substantive due process” constitutional law doctrine. The Fifth Amendment’s due process clause limits what the federal government can do vis-à-vis individuals. A clause in the Fourteenth Amendment is nearly identical, and identical in substance, to the Fifth Amendment’s due process clause, except that it limits what state governments can do vis-à-vis individuals.
SCOTUSblog’s Lyle Denniston’s early report suggests that I was right. The outcome of the case, he predicts, will depend on whether Kennedy believes that the Court can uphold the mandate provision without opening the door to unlimited congressional mandating of purchase specific things, not because Congress lacks that power under the Commerce Clause but instead because it violates liberties protected under the Fifth Amendment’s due process clause. Denniston does not mention the Fifth Amendment, but, whether or not the justices themselves did specifically, that is the upshot.
The “substantive due process” doctrine holds that there are certain incursions into personal autonomy and certain impositions on individual liberty beyond which the Constitution allows the government to go. It is this doctrine by which the Court has stricken down such laws as state laws barring the sale and use of contraceptives, state laws prohibiting abortion under all circumstances (Roe v. Wade), and state laws criminalizing sodomy.
But based on Denniston’s early report about the nature of Kennedy’s concerns, I don’t see how, absent an utterly artificial Commerce Clause-based ruling, a ruling that the mandate unconstitutionally infringes upon person choice, upon personal liberty, would not also mean that Massachusetts’s “Romneycare” law, and state laws that require drivers to purchase auto insurance, would be constitutionally permissible.
Kennedy likes to wax eloquent, as he did last year in an opinion in a case called Bond v. United States, about how divisions of power among various governments—by which he means state governments vs. the federal one—protect individuals from tyranny. (He’s usually less interested in constitutional checks than on balances to state power—especially to state-court power—but that’s another subject.) In Bond, he said, rightly, in my opinion, that a person indicted under a federal criminal law has legal “standing” (the legal right) to argue that the federal statute unconstitutionally infringed upon an area of criminal law reserved solely for the states to address, because the federal statute impinged (literally, in that case) her personal freedom. So if the problem with the insurance mandate is that it exceeds Congress’s authority under the Commerce Clause, then a ruling that the ACA, a federal statute, is unconstitutional would not affect state statutes.
But that’s a separate issue from whether the mandate is an unconstitutional violation of personal liberty irrespective of whether or not the Commerce Clause power would allow Congress to enact the law. And under the Court’s longtime Commerce Clause jurisprudence, Congress does have the authority to legislate the mandate to buy health insurance, given the impact on the healthcare market of the uninsureds’ usage of health care. A ruling to the contrary would be transparently artificial. Which probably won’t matter to Kennedy.




51 Comments

I maintained at the time the auto insurance laws were passed that they were unconstitutional. If the state mandates insurance, the state should provide insurance – like it provides flood insurance. I was concerned about the precedent – which Obamacare advocates conveniently ignore and opponents rarely mention.
Now we have that pernicious auto insurance law being cited as precedent for Obamacare (it’s not) and, if the law stands, we will, in the future, have to hear Obamacare cited as precedent for the next corporate ripoff.
Operation of a motor vehicle is currently considered a privilege afforded you by permission of the state; thus driver’s education courses, qualification testing, permitting of drivers through licensing and registration, and ultimately, proving to the state your financial responsibility to operate a motor vehicle (insurance). This area is usually considered black and white. The very grey area is where does health care fall under this spectrum. That the states license medical practitioners and not their patients may be the better way to look at the issue – and a mandate in effect presumes to act as a license on patients.
The big difference, of course, is that car insurance is designed to provide for the damage you and your car cab do to OTHERS, whereas health insurance is designed to protect you.
Not in the case of the ACA. In the case of the ACA health insurance is actually being provided to protect both the hospitals and those already insured from having to pick up the tab of those not insured. It even goes as far as to protect insurance companies. Individuals in need of health care-not so much.
I dont have any trouble at all separating mandating car vehicle insurance and mandating the purchase of “health care” – of highly dubious value. As it has been pointed out, owning and operating a motor vehicle is, no matter how important to individual mobility, completely optional. The govt. is not mandating that everyone buy vehicle insurance whether or not they own and operate a vehicle – against the likely hood that SOMEDAY,you will PROBABLY own a car. The health care mandate is too much like being taxed for the existential circumstance of being born. Much more like feudalism.
Hmm strange question I know, but what about the law saying you have to wear a helmet on a bike. That forces you to buy a helmet. Is that constitutional.
Hhhmmm, aren’t the conservatives on this Supreme Court quite able to compartmentalize cases, and the logic or illogic entailed, when it suits their purposes>
Perhaps they will invoke the Bush v. Gore decision caveat that it’s just a one off which applies only to this particular case.
Hey, it worked back in 2000….
Not so fast…..my 19 year old son was going to be cut from our insurance unless he went on to college. He applied to college on the day he turned 19. A few months later he had an appendix attack and had surgery which created a hospital bill alone of $26,000.00 Because of paperwork problems. the hospital was informed that he was not insured. The hospital cut the bill down to reflex the “none insurance price”. When the matter was resolved a few months later, and the insurance company agreed to pay the bill, the hospital raised the price up again and informed us he was now required to pay the “insured price”. This price according to the hospital helped with non insurance claims.
Digby today:
“If anyone thinks that the case against Obamacare isn’t strictly political or that the Supreme Court must decide it on the merits they are sadly deluded. I’m sorry that’s the way it is, but that’s the way it is. The only way the health care bill survives is if Anthony Kennedy decides to make himself into a right wing target or John Roberts sees more to be gained politically by upholding the law than striking it down. That’s how this works today. Maybe it always has.”
The individual mandate is egregious. If the asshole justices of the SCOTUS – the Scalito Axis – succeed in throwing out the mandate provision as unconstitutional, their only motivation will have been undermining a key “achievement” of the Obama presidency, and the irony will be that they will be throwing out a plan from the Heritage Foundation, from which their high-level legal careers emerged. And to double the irony, the asshole justices will have succeeded in throwing out a total giveaway to the health insurance and pharmaceutical lobbies.
Another consideration is do Roberts and his right wing flunkies overturn Obamacare just because of their partisanship, or do they uphold it for their corporate masters?
FWIW, I don’t think their masters would mind much if it is struck down in its entirety.
This is not an easy decision for the Roberts court. As I said above, the industry wants this mandate, the corporate interests, which Roberts, Alito, Kennedy, Thomas, and Scalia adore. On the other hand, they and the party they belong to intensely dislike/hate Obama, but then, the GOP can get a ton of mileage out of this if the law stands. We’ll be hearing “repeal Obamacare” until November. The GOP can’t do that if the SCOTUS does their work prematurely.
Decisions, decisions, decisions.
Nah, the health industry wants all that extra cash. Most of the ACA is a giveaway to the industry.
But don’t state laws requiring auto insurance apply to purchasing and registering a vehicle, rather than obtaining a license to drive? At least that’s been the case in the several states where I’ve lived. I’m thinking maybe it’s not a good analogy for the juggernaut on ACA.
I’ve grown to dislike analogies. Too often they seem clever but come up short in substance. I agree with your observation about Kennedy’s waxing. Aren’t they all narcissists at heart? There’s a “look ma, no hands!” about them.
I’d like to take a moment to proclaim my antipathy of our beloved three tier system.
I really wish someone would ask hospitals why it is that they get to randomly assign values to procedures? Insurance companies suck but the medical community needs to quit the shell game where they up the “cost” in order to collect 1/5 of that from the insurance company.
I’m surprised that your son’s original bill was small. My rate for the non insured visit to an ER was $6000. When the paperwork for my husband’s insurance went through(we were in the middle of “verification” that occurs annually) the negotiated cost to the insurance company was $2000.
So then we’ll have mandates to buy caskets so that we don’t cost shift the expense to family or the tax payers, we’ll have a mandate that people eat healthy so that they don’t raise the expenses for others in the insurance pool, they’ll be a mandate to have a gym membership for the same reason. Just about any activity or non-activity that you can think of impacts health one way or the other – heck smoking [anything] could be banned as part of the same principle. All this is within the realm of healthcare insurance pools and even though these are all a wide variety of things, they would fit as part things that impact the healthcare market.
Pretending you aren’t partisan assholes in robe is such a “quaint” notion. I’m sure that when the Roberts crew retires to their chambers tonight they’ll ask ALEC to weigh in via teleconference.
Their official position is (a) no stand on the constitutionality of the mandate but (b) it’s all or nothing on the law. If the mandate goes, everything else has to go. Health care economists are divided on whether industry profits would rise or fall if the law is COMPLETELY overturned.
But, YMMV and who knows?
I’ve been deferring to your reasoning before that passage right there, from there forward I give you no lattitude for opinion
driving a car is a license, licenses necessarily have provisions, the entity issuing those licenses have pretty close to free range on what and what does not qualify an individual for said license
now, if you wanted to make the claim that driving is a right protected by the constitution then you’d have that case, however you don’t make that case nor would you dare
You’re right! All those stupid State laws are unconsitutional also, but I don’t think anyone really understands the underlaying problems this economy will have once the ACA is fully implimented.
The problem I see is this:
Uninsured people today go to emergency rooms to get medical treatment, and they don’t pay the bill, because the cost is too high. The cost is then reduced and paid by the State govt, which in most cases gets it from the Federal govt, who got the cash by borrowing it. So today most uninsured healthcare is paid for by the Federal govt borrowing the money.
After the ACA goes into effect most uninsured healthcare costs will be paid by we the people through increased primium payments.
What we really need is a single payer system, where the insurance companies and there profits are removed. This will bring costs back down to being affordable.
You can choose cremation in leiu of burial.
We already penalized smokers during the SCHIP debate(despite the evidence that costwise non smokers and smokers are a wash in terms of cost)with an increase in the tax on cigarettes to pay for kids’ health care.
Additionally employers are already penalizing those that choose unhealthy lifestyle choices.
http://www.nytimes.com/2011/11/17/health/policy/smokers-penalized-with-health-insurance-premiums.html?pagewanted=all
Additionally they’ve incentivized good behaviors.
http://www.evolvedemployer.com/2011/05/18/how-wellness-programs-can-nurture-corporate-budgets/
My husband actually has a fully covered gym membership paid for by his employers.
Unlike the cost of an ER visit(that by law means a person must be treated) from an uninsured person, the market seems to be handling all of the things you mention.
I call bullshit.
Unless you live in ass-backwardsville, the non-insured get charged a higher rate than the insured at hospitals.
This is not exactly a secret.
Insurance companies have pre-negotiated “discount” prices for their insured.
They’ve already raised rates in “anticipation” of having to follow the law. My money in this rigged game is they manage to extract more. They always manage to extract more.
You’re being transparently artificial /s
I think it is possible that the discount she speaks of is the rock bottom price the hospital decided to charge after they realized they weren’t going to get the original 5x the rate of an insured person cost.
It’s quite the shell game the hospitals play. They charge 5x the cost to Joe Average in order to make the insurance companies think they are getting quite a deal. They charge Joe Average an exhorbiant sum and then “settle” for a much smaller sum in hopes of recouping some of the costs.
I’d be hard pressed to guess what an appendectomy costs based on a screwed up system that charges you $6000 until you tell them you have an insurer who they are willing to accept $2000 from. And if you don’t have that insurer that they’d be willing to accept $2000 from then, “hey let’s just accept $3000 on account of the fact that we’re a bunch of humanitarians and the fact that you haven’t sent us ANY of that $6000 yet.”
Ugh. Our system has major suckitude.
righhhhhtt
the people being artificial are those who think the mandate for health care is the same thing as a mandate for insurance, talk about artificial, that argument takes the prize
You may be interested to learn that a few years ago the health care industry successfully lobbied Congress to allow them to convert medical debt (which had limitations on the amount of interest they could charge on the unpaid balances) to consumer debt (which has no prohibition on usurious interest rates and terms).
This is why they do not cut the type of deals that you describe.
You say that when an uninsured person goes to the ER, the cost of their visit is picked up by the state. That is erroneous. Most people whom the state chooses to insure are insured – they may be immigrants newly arrived and on County or state insurance, or a mom or dad on AFDC, who also has state r county insurance.
When a person is not insured, often it is because they are no longer working in Corporate America. They don’t have the employers’ clout to get insurance at a decent rate. A pre-existing condition or disability might make health insurance prohibitively expensive. Or they may be in their fifties or early sixties, and find health insurance is too expensive. So when they end up in the ER, and let’s say it’s a serious matter like a stroke or a heart atatack – guess what? The hospital now owns their retirement monies, or their house, or possibly BOTH!
it’s an absurdity in our new serf economy to pay as much as min. wage for health insurance.
so I just had an epiphany;
I’ve said before, I do not believe obama would have forced this case to the supreme court before the elections (which he did) if he was not given some kind of guarantee that the decision would fall on his behalf
so either the right wing justices are playing a good poker face or they gamed obama.
I really can’t believe the justices will take away this desert from the mouths of the insurance companies, however if they do, they really REALLY wanted to embarrass the zero
I agree with you!
the individual mandate is an insurance industry super bail out!
looking at Rachel, one would think the liberals like the individual mandate?
progressives hate the individual mandate, just like conservatives!
how many dems are going to run for office in 2012, telling people they love OBAMACARE? NONE
The GOP has gamed Obama many times, so maybe the SCOTUS thinks it’s their turn now.
Like I’ve said and others have to, the court has to decide where its real loyalties reside. Either they uphold the mandate for their corporate pals, or their eagerness to humiliate Obama may overtake their loyalty to their corporate pals.
How will the Supreme Court’s ruling on the ACA and individual mandate impact Mitt Romney’s campaign for president? (for some reason I’m reminded of Bush v. Gore).
Rick Santorum keeps repeating that Mitt Romney is the worst Republican in the country over health care to run against President Obama, what with Romney’s Massachusetts’ “individual mandate” background, and this is just during the Republican primary contest.
So, how does this play out leading up to the November presidential election, whether the Republican justices on SCOTUS shoot down the ACA and individual mandate or not? If Mitt Romney is the Republican nominee facing President Obama in November then how will the ACA and individual mandate, whether shot down or not, be used by either political party?
I feel that this will be what drives Republican SCOTUS justices in their ACA and individual mandate decision, since after Bush v. Gore, we know that they only rule in favor of Republicans and what will help Republicans (and their Citizens United financial backers) in their endless War On Democrats. I figure that these Republican justices (all Catholics) will strike down the ACA entirely along with the individual mandate, not only to embarrass the Obama administration over President Obama’s signature legislation involving health care, but also so that whoever ends up as the Republican nominee (along with unlimited Super PAC money) can issue countless ads attacking President Obama over the “failed” ACA and individual mandate. IOW, I have hard time believing that these ultra-partisan justices, including Kennedy, will want the ACA and individual mandate to still be in place leading up to the November elections, and their obvious rushing to a ruling indicates that they want to strike it down as quickly as possible, hoping, I guess, that Rick Santorum’s slam on Mitt Romney will disappear as well, undercutting any attempt by the Obama administration to link Mitt Romney to the individual mandate, especially if SCOTUS rules the ACA unconstitutional in its entirety. (Which is why they’ll rule it entirely unconstitutional, not just the individual mandate).
I am personally surprised anyone wanted to compare this mandate to “regulating commerce”, it’s one thing to regulate an activity that is already taking place but using the argument some people are making, this is exactly the same thing as saying;
The government will force you to have a drivers license, then we will force you to buy a car, then we will force you to buy insurance”
now THAT’S the correct analogy when comparing this health insurance mandate to auto insurance
I agree.
New Dems running for office in 2012 will not endorse OBAMACARE
ObamaCare was a complete waste of time! the only issue the last 4 years has been the Economy
ObamaCare was an insurance bailout.
the individual mandate is hated by liberals and conservatives, it is a 1% idea and wet dream
I think you may have missed my sarcasm tag
I saw it too late to edit my post, thanks spanishinquisition!
I used to work in the health care field. First in the Navy and then later for For profit HCA. I know that while I was at HCA that they did indeed cut deals with patients. I have good insurance so I haven’t had billing issues. I’ll have to troll around my fairly low income neighborhood and see if I can find someone who has had no insurance. I’m going to bet money that they have “programs” for the uninsured though.
This court invents rules of procedure/thought/evidence so as to get the political decision it wants (Gore v and Citizens being cases that come to mind).
75% of the public no longer expect the court to follow “law” in making any decision
So does Roberts want that 75% to grow – to lock in that 75% for at least a few decades – destroying any legitimacy that future decisions might have and indeed destroying respect for the law in general, or do two 5/4 political decisions in 12 years not need a third because of Roberts’ respect for the Court’s role as an “unbiased judge” and wanting that role to return?
I’m betting there will be a third political 5/4 decision because these folks are results oriented – the result that is important is the one the rich and corporate want.
Psssst, you’re mistaken.
They do indeed have programs.
http://gahap.org/wp-content/uploads/2010/08/Charity-Care-and-Financial-Discount-Policy.pdf
Killing ACA will only re-open the door to single-payor.
Killing ACA kills everything, the public, government, and the insurance companies, leaving medicare for all as the only public solution, sending insurance companies to concentrate on other products, like face-lift insurnace.
May I suggest that life is better lived with the understanding that right-wingers, in this case the Court’s Falangist 5, has no interest in, use for nor concerns about consistency, cogency or constancy. If one is truly intrigued by irrationality, caprice and/or absurdist theatrics one can both indulge those interests via world-class literature from luminaries such as Kafka, Beckett, Pinter or Vonnegut and be improved by it in the process. Conversely, one is only diminished by giving the right the gift of your time and attention. In the end, it is always better to win an election – or a matter before politicized court – than it is to win an argument.
I do agree that the Flanagist 5′s ideological felling of the ACA presents the “left” with the opportunity to institute true universal health care for all – just not on Obama’s watch nor as long as the right holds 51 votes in the Senate (from their own caucus or aided by the Lieber/Nelsons of the future).
Any chance we’ll see FDL entries recounting Obama’s secret meetings with insurance, hospitals and doctors lobbyists particularly those in which he traded-away “Medicare for all” for, as they say in baseball, a player to be named later?
Just think, if Barry had the fortitude and character of the base that worked for him and the electorate that made him President, we’d have single-payer healthcare without the distractions of entertaining the SCOTUS’s Flanagists – an ideologically pure voting block who knew years ago how they’d each “decide” on matters of enriching healthcare’s supply-side at the “cost” of allowing for marginal improvements in demand-side outcomes.
Imagine what Speaker Pelosi could have accomplished were she to have had a President with balls.
Thanks for this wonderful post. This is the first time I’ve heard the 5th amendment/14th amendment argument raised and argued so convincingly. This is just another reminder about why I always come to FDL first–intelligent people with fresh ideas who aren’t beholden to a political party. What a concept!!
Just as they did after defeating the Democratic effort to prove affordable health care under Clinton, the GOP is saying that they recognize that health care distribution and costs are an important issue for the American people and they’ll have a plan if you just elect them to a majority in 2012. What did they do when they had control of all three branches from 2000 to 2008? Nothing. And health insurance premiums doubled.
If they get their way and the Act is overturned, it’s back to the past. 15 million children will lose coverage they’ve had for existing disabilities, 2.5 million young adults get knocked off their parents policies, the insurance companies don’t need to rebate premiums back to you if their Medical Loss Ratio is below 80%, small business lose that tax credit of 35% for new plans, no disclosure of financial relationship between doctors and hospitals and drug manufacturers, etc.
And as health costs go up, those people choose to “self-insure”, their bills will just keep getting added to your premium.
I prefer Dave Lindorff’s take:
http://www.counterpunch.org/2012/03/26/why-the-supreme-court-should-kill-obamacare/
It is just that a tithe to be paid to a Noble not to the State for Health Ins. mandated by the KING or else. It’s a form of neo-feudalism and nothing else. The problem is we are now ruled by fascists who hide behind the paper thin veneer or fig leaf that America is still a Republic and a quai-democracy. Neither are any longer true. We live in an Imperial Nat’l Security State owned by a few hundred Int’l Corps. and they’re Oligarchic owners. We are now subjects of this Empire of $$ not citizens of a Republic. As the BVSHites loved to say to us arrogantly , GET OVER IT! Move on nothing to see here.
States can pass laws mandating insurance coverage, because states are the ones with Insurance Commissions and the jurisdiction to regulate that insurance. Whether the Federal Government can mandate something it doesn’t have the jurisdiction to regulate (because States already have that power) is one of the Constitutional Questions (I believe).
As a commenter up top mentioned, health insurance and car insurance deal with different things.
The State minimum mandate for car insurance 1) only applies if you already own a vehicle. If so, you have to purchase Liability Insurance (in case you hit someone else, your policy will pay their repairs.
2) If you have a Lender financing the vehicle, the Lender is allowed to require that you purchase Comprehensive and Collision Coverage. That is for repairing your own vehicle. You can also opt to purchase Uninsured Motorist Insurance (in case the other party hits you and has no insurance.
Does any of that cover Car Maintenance? No. Does it cover Breakdowns from wear and tear? No. That is called a Warranty. Not INsurance.
Does every car get in an accident? No. Does every car need routine maintenance, annual checkups, regular tune-ups? Yes. Does insurance cover any of that? No.
Human beings – health insurance won’t cover anything we might do a third party. Health Insurance doesn’t pay for the damage we might cause somebody else if we hit them. Human beings are not collateral to a Lender, like a car is, and therefore no Lender is going to require that we get Comprehensive Insurance to cover our own damage caused by somebody else. Professionals who need to be bonded have that kind of coverage. Bonding Agencies and Professional Liability Insurance (Like Legal Malpractice, Medical Malpractice, etc) are very similar to the Car Insurance analogy.
People need maintenance, checkups, tune-ups. We are like vehicles in that we need to have routine work done. Car Insurance doesn’t cover Vehicle Maintenance. Health Insurance does cover Human maintenance. I think the analogy of Health Insurance to Car Insurance is obfuscatory and misplaced. Health Insurance is analogous to Vehicle Warranties. And does the state mandate we purchase a warranty? No. It only mandates insurance because that is a way to pay for Liability when damage is caused to a third party. Because vehicles are like deadly weapons when they go above 20 mph. Human beings – its hard to mandate that we get insurance for our existence. Nobody has the power to opt out of that. Medicaid for All, using the taxing authority of the state, without an INsurance Financial Product middleman is the only way to ensure full access and fair prices without the profit-seeking price-gouging financial vampires coming between patient and doctor. Peace.
It is my understanding, via our lawyer, that any hospital that accepts medicare/medicaid, is prohibited by law from charging the uninsured more than what those programs would reimburse them, plus somewhere between a 10 – 12% “profit”. Charging the uninsured more is considered, again according to our lawyer, a violation of the rights of the uninsured.
This, however, doesn’t mean squat, nor does it stop the hospital’s from doing just that.
Hence the lawyer.
Something else to consider when thinking about car insurane/health insurance analogies.
Car insurance isn’t used very often. People aren’t filing claims on their policy 5-10x a year for their car. That would 5 to 10 wrecks a year. Imagine your premiums! The reason car insurance is so “cheap” (relative to health insurance premiums) is because cars have a certain fixed ceiling in their costs. At some point, if the damage is too much, the insurance company may just tell you to buy a new car instead of paying to repair a totalled one. Health insurance is used every time we go for a checkup. So, it costs a lot more due to frequency. For a state to mandate car insurance is not a deal killer for most Americans. They can either afford it, or they take the bus/ride a bike/walk/get a cab/etc. They can make that cost/benefit choice and still keep money in the wallet. With health insurance, its a deal-killer out of the box. Premiums are nowhere close to comparable to life insurance, home insurance, or car insurance. So, my other comment about how health insurance is more like a vehicle warranty aside, it still doesn’t break the back for a state to mandate vehicle insurance. Without better cost control on the premiums, mandating it becomes a nightmare in so many people’s minds. And with employers no longer providing it (which they never did with car insurance), the entire mechanism starts to unravel. Car insurance has a built-in cap, in a way. Like gas prices. At some point, the price just can’t go above a certain threshold without significant numbers of people just riding bikes (like in Europe) or taking light rail. With health insurance, what are people supposed to do when the premiums pass that threshold? There’s not much they can do. Either they pay it or they don’t. To penalize them for not paying it becomes hard for most people to understand. Its not a good PR move, to say the least.