Health Affairs

Legal Challenges to the Affordable Care Act

Bethesda, MD -- A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the issues inherent in the lawsuits filed by state governments, organizations, and private citizens challenging the Affordable Care Act. To date, about 30 legal challenges have been filed. Federal District Court decisions have been split, with four judges ruling that the law is constitutional, and two judges ruling that it is not. The Sixth Circuit Court of Appeals, the highest court yet to issue an opinion, recently upheld a ruling on the law's constitutionality. It is almost certain that the matter will move to the US Supreme Court for review by its nine justices.

Most of the lawsuits have focused on what is known as the individual mandate. Starting in 2014, most US citizens, nationals and legal aliens must maintain "minimum essential health coverage" or pay a penalty. By requiring nearly everyone to maintain health insurance, the insurance pool will expand to include healthy Americans, making it financially viable for insurance companies to cover people regardless of their health condition.

This policy brief details the following:

The rationale in the law and the legal arguments for and against the Affordable Care Act. The plaintiffs' main argument is that not buying health insurance is "inactivity," which cannot be regulated by Congress since it is beyond the reach of the Constitution's commerce clause. The key defense of the Obama administration is that the decision to purchase or not purchase health insurance impacts the overall national health care market--and so does constitute interstate commerce, an activity that Congress may regulate.

Background on the court rulings to date. The brief summarizes the cases that have been heard by different federal District Courts and explains the rulings. Six of these cases have been appealed, and on June 29, 2011, the Sixth Circuit Court of Appeals ruled in favor of the mandate.

Next steps. Decisions in most cases under appeal are likely to be issued during the summer. The matter is almost certain to be taken up by the US Supreme Court, especially if the various appeals courts hand down contradictory decisions. It is not known when the high court will act, but it could be as early as its next term, which begins this October.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at www.healthaffairs.org. You can also find the journal on Facebook and Twitter and download Narrative Matters on iTunes. Address inquiries to Sue Ducat at (301) 841-9962 or sducat@projecthope.org