Legal Challenges to Health Reform

The Supreme Court will hear arguments on the constitutionality of the individual mandate. A decision is expected in 2012.

A recent federal appeals court ruled that Congress can require Americans to obtain health insurance coverage, as under the Affordable Care Act (ACA).

Since the law’s passage in March 2010, state governments, organizations, lawmakers and private individuals have filed about 30 such lawsuits. In one, attorneys general of 26 states, led by Florida, are collectively seeking to overturn the law.

A central claim of the litigants is that the law’s “minimum coverage requirement,” popularly referred to as the individual health insurance mandate, exceeds the scope of the U.S. Constitution’s “commerce clause,” which gives Congress the authority to regulate interstate commerce. Challengers say this makes ACA unconstitutional. ACA supporters assert that because spending on health insurance and health care constituted 17.6 percent of the U.S. economy in 2009, the mandate is “commercial and economic in nature, and substantially affects interstate commerce.”

To date, federal District Court judges in Florida and Virginia have ruled in favor of litigants, while judges in Michigan, the District of Columbia and again, in Virginia, have upheld ACA’s constitutionality. As of June 2011, cases challenging the law were pending in more than half of the country’s 13 United States Courts of Appeals.

This Health Policy Brief examines several lawsuits challenging the constitutionality of various aspects of the ACA, and was published online on November 30, 2011 in Health Affairs.