Today, Judge Roger Vinson heard oral arguments in the multi-state lawsuit claiming that the provision of the Affordable Care Act requiring most Americans to either carry insurance or pay slightly more income taxes is unconstitutional. After the hearing, Florida Attorney General Bill McCollum (R) co-hosted a press conference in which he expressed optimism that the landmark law would be strike down. As part of this conference, however, McCollum attributed an unfortunate view to Judge Vinson:

One of the things he kept saying…was there are other options, aren’t there, besides this approach, besides requiring you to buy health insurance. There are other ways to skin the cat, so to speak. And he said that several times today…like when you go into, I think he said an emergency room, for example, you know, maybe you could, at that point, be required to buy insurance.

Watch it:

Given his role in challenging the Affordable Care Act, McCollum obviously isn’t the most reliable witness. Nevertheless, it would be quite unfortunate if Vinson did actually suggest this alternative mechanism, since it is guaranteed to fail.

The reason why the Act requires people to carry insurance is because the Act also prevents insurance companies from denying coverage to people just because they are already sick. Patients with preexisting conditions cannot be protected unless the law also prevents them from entering the insurance market at the last minute — an act known as “adverse selection“:

This happened because of a phenomenon known as “adverse selection.” Adverse selection occurs when consumers delay purchasing health insurance until they become ill or injured — thus forcing the insurance plan to pay them substantially more in benefits than they previously paid in premiums. When one consumer engages in such a delay, everyone else’s premiums must rise to cover that consumer’s costs. When many consumers engage in this delay, the results can shut down an entire insurance market.

Seven states attempted to ban preexisting conditions discrimination without also requiring everyone to carry a minimum level of coverage, and all of them saw their premiums skyrocket. Several states that tried doing one without the other saw their entire individual insurance market collapse. (Massachusetts, by contrast, enacted a law that was very similar to the Affordable Care Act and its premiums declined by 40 percent in the individual insurance market.)

Yet, if McCollum is to be believed, Judge Vinson floated the idea that the solution to this adverse selection problem is, well, adverse selection.

As Republicans and their Tea Party allies lay out the roadmap for repealing the health care law in January — the current plan would have them voting on full repeal in the first days of Congress, followed by separate votes to repeal individual provisions like the individual mandate and the 1099 requirement — House Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) is out with this report explaining why the GOP’s plan to dismantle health reform is “dangerous to America’s health.”

I’ve been arguing that health reform advocates have a real opportunity to use the upcoming repeal hearings and votes as a way to reinforce — unspin, if you will — all of the lies told about reform. Seventy percent of voters who recalled seeing a health reform ad during the midterm elections said it was in opposition to the Obama plan. If the Democrats hope to shore-up support for the measure, they will have to clearly spell out what the law does and how GOP repeal will take all of that away. Stark’s report does just that:

- If Republicans repeal health reform, they will eliminate these new tax credits and the cost-sharing assistance, leaving tens of millions of people unable to afford coverage.

- Simply stated, by repealing health reform, Republicans would cause the deficit to skyrocket.

- To prevent working families from facing crippling medical costs, the health reform law limits what insurers can force enrollees to pay in out-of-pocket expenses and limits their ability to exclude coverage for pre-existing conditions. Republicans would repeal these protections, putting millions of consumers back at risk for bankruptcy if someone gets sick.

- Republicans have promised to repeal the health reform law and thereby eliminate this key coverage improvement – forcing senior citizens and people with disabilities to again pay too much for their life-saving medications.

- Republicans would repeal these small business tax credits – raising taxes on these small businesses which would likely result in them dropping health coverage for their workers.

Look:

Democrats adopted this line of debate immediately after they passed the law and they will need to return to it in the new Congress. The good news is that the American public has always been highly supportive of the individual provisions in the law and health reform advocates need to ensure that everyone understands that that’s what Republicans want to repeal.

This afternoon, following oral arguments in the Florida-based multi-state challenge to the Affordable Care Act, Attorneys General Greg Abbot (TX) and Bill McCollum (FL) held a press conference on the steps of the court house, in which the pair made two very peculiar arguments against the health care law. McCollum bragged that if the mandate is declared unconstitutional, the insurance companies will again be allowed to discriminate against individuals with pre-existing conditions. Abbott complained that the requirement to purchase coverage hindered the freedoms of billionaires:

ABBOTT: There are so many, perhaps millions, who are in their 20s who don’t need access to health care, who may not go get any health care….On the other hand, there are people who are worth billions of dollars who may choose to pay the high end of costs for health care, more than what the average American would have paid and not have any kind of health insurance. They should have the freedom to pursue that path also.

Watch a compilation:

McCollum’s first point about losing the insurance regulations is well taken, but it’s nothing to celebrate. If the mandate is repealed and insurers are required to offer coverage to individuals once they become sick, costs will increase costs for the company and will be passed on to everyone in the risk pool. In fact, I would argue that even if Congress adopts some other alternative to the mandate in an effort to save the insurance regulations– that does half the job of encouraging healthier people to purchase insurance — the industry will lobby hard to also eliminate the protections that allow those with prior conditions to be eligible for coverage.

Lower income Americans with pre-existing conditions will be most affected by this policy change, but for some reason Abbott is much more concerned about the “people who are worth billions of dollars.”

Today, a Republican judge in Florida will hear oral arguments in the most high-profile lawsuit challenging the Affordable Care Act. The crux of the plaintiffs’ argument in that case is that, if the federal government can require individuals to carry health insurance, then it is “difficult to perceive any limitation on federal power,” and this would be inconsistent with the structure of a Constitution that gives the federal government a list of very broad, but not infinite, powers. Libertarian writer Radley Balko frames the same argument somewhat more pointedly:

Putting aside what’s codified Bill of Rights, which was ratified after the main body of the Constitution, do you believe the Constitution puts any restrictions on the powers of the federal government? If your answer is yes, what restrictions would those be?

And what test would you use to determine what the federal government can and can’t do? I’ve written this before, but after Wickard, Raich, and now, if you support it, the health insurance mandate, it’s hard to see what’s left that would be off-limits. I mean, during her confirmation hearings, Elena Kagan couldn’t even bring herself to say that it would be unconstitutional for the federal government to force us to eat vegetables every day.

This claim that upholding the Affordable Care Act would lead to limitless federal power has been a powerful talking point for the far right for quite some time now — but it lacks any basis whatsoever in reality. The truth is any number of essential laws, including laws criminalizing murder, rape, incest or assault, stretch well beyond Congress’ power under existing doctrine.

Because the Constitution speaks of laws that “regulate commerce” and not laws that have only a tenuous impact on the national economy, the Supreme Court casts a skeptical eye on federal laws that are not economic in nature. Thus, in U.S. v. Lopez, the Court struck down a federal ban on guns in school zones; and in U.S. v. Morrison, it struck down a law providing federal remedies to the victims of violence against women.

But if Congress can’t prevent violence against women, it follows that Congress also could not prevent other forms of violence, which is why a federal law criminalizing murder or assault is largely off the table. Congress could enact a limited ban on murder incidental to some of its other powers — because Article I of the Constitution empowers Congress to establish post offices, for example, Congress could make it illegal to kill or assault a postal worker during while they were engaged in their official duties — but a blanket federal law forbidding all murders is right out.

Similarly, consensual sex is not an economic activity any more than the mere act of bringing a gun into a school zone is. For this reason, the once-ubiquitous state laws regulating sexual morality could not be enacted by Congress (even if they weren’t also forbidden by the Fifth Amendment under Lawrence v. Texas). The Commerce Clause enables Congress to regulate the national markets in goods related to sex — pornography, contraception, sex toys and the like — but non-economic sexual morality laws are largely off the table.

Lopez also contradicts Balko’s claim that upholding economic regulations such as the Affordable Care Act would also empower Congress “to force us to eat vegetables every day.” Eating a vegetable, like bringing a gun into a school zone, is not economic in nature, so a federal mandatory eating law does not fit within Congress’ power to regulate commerce. The Constitution gives Congress the power to raise taxes and spend money, so Congress could tax individuals and then use that money to purchase vegetables — something it already does through programs like food stamps or federal school lunch subsidies — but it does not have the power to force anyone to eat those veggies.

One thing that Congress clearly does have the power to do, however, is to regulate the national health insurance market. It just doesn’t follow from this fact that Congress must also be allowed to do anything else.