First Ever Decision On Constitutionality Of Health Reform Upholds The Law

doctor_patientToday was a victory for the Affordable Care Act. The first court decision to render a verdict on the constitutionality of the landmark health reform package upheld a key portion of law. Earlier today, Judge George Caram Steeh of the Eastern District of Michigan handed down a twenty page order dismissing a challenge to the Act’s minimum coverage provision on the merits:

“In assessing the scope of Congress’ authority under the Commerce Clause,” the court’s task “is a modest one.” The court need not itself determine whether the regulated activities, “taken in the aggregate, substantially affect interstate commerce in fact, but only whether a ‘rational basis’ exists for so concluding.”

There is a rational basis to conclude that, in the aggregate, decisions to forego insurance coverage in preference to attempting to pay for health care out of pocket drive up the cost of insurance. The costs of caring for the uninsured who prove unable to pay are shifted to health care providers, to the insured population in the form of higher premiums, to governments, and to taxpayers. The decision whether to purchase insurance or to attempt to pay for health care out of pocket, is plainly economic. These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers, and the insured population who ultimately pay for the care provided to those who go without insurance. These are the economic effects addressed by Congress in enacting the Act and the minimum coverage provision.

Although Judge Steeh is the second judge to dismiss a challenge to health reform — last August, a George W. Bush appointee dismissed a health care case on procedural grounds — he is the first judge to reach the merits of whether or not the law is constitutional. Interestingly, Steeh sided against the Obama Administration’s three procedural arguments that would have effectively delayed any litigation challenging the ACA until 2014, before completely rejecting the plaintiff’s claim that the law is unconstitutional.

This case is far from over, however. Judge Steeh’s decision will appeal to the notoriously right-wing Sixth Circuit, a Court which tried to manipulate federal election law to benefit the Ohio Republican Party in 2008 before being unanimously smacked down by the Supreme Court just three days later. If the Sixth Circuit reverses Judge Steeh, that decision is almost certain to be reviewed by the Supreme Court.

In the end, however, there is no question that Steeh reached the correct decision. Even ultra-conservative Justice Scalia agrees that Congress has sweeping power to regulate “economic activity,” and there is simply no question that health reform will have an enormous economic impact on the health insurance market. In other words, today’s decision will be the first of many affirming the Affordable Care Act.


On the same day that a federal judge upheld key provisions of the Affordable Care Act, the Chamber of Commerce — which spent millions in a failed campaign to keep reform from becoming law — announced that it would dedicate its considerable resources towards invalidating reform through the courts:

Thomas Donohue, the chamber’s president and chief executive, said on Thursday the nation’s largest business lobby is beefing up its staff so it can fight health care and financial regulation reform in court.

“Litigation is one of our most powerful tools for making sure that federal agencies follow the law and are held accountable,” Donohue said in remarks prepared to be delivered in Des Moines, Iowa.

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