Examining the Evidentiary Basis of Congress's Commerce Clause Power to Address Individuals' Health Insurance Status

The Patient Protection and Affordable Care Act (ACA) requires individuals to buy minimum health insurance coverage or pay a penalty. Whether or not Congress has the power to require this will be decided by the U.S. Supreme Court. One of the chief arguments made by ACA advocates is that Congress has the right to regulate interstate commerce—the “commerce clause.” But first, the court must decide whether being uninsured substantially affects interstate commerce.

These authors assert that the economic spillover effects of being uninsured impacts not only the individuals and their families, but more importantly, community and regional health care systems and the economy as a whole. Among the consequences of uninsurance gleaned from vital statistics data: (1) a quarter of pregnant women are uninsured for part or all of their pregnancies, putting pressure on the health system and public programs like Medicaid; and (2) ten percent of nonfatal injuries are treated in the emergency department, without regard to patients’ ability to pay.

Given the inevitable and universal need for health care, the authors believe that “the framework for analyzing the constitutionality of the minimum essential coverage requirement should be the stability of the larger health care economy, of which insurance plays a crucial financial role.”

Reproduced with permission from BNA's Health Care Policy Report, 20 HVPR 232, 02/06/2012. Copyright 2012 by The Bureau of National Affairs, Inc. (800-372-1033) http://www.bna.com