Title: The Constitutionality of the Affordable Care Act: An Update | Journal of Ethics | American Medical Association
Headings: The Constitutionality of the Affordable Care Act: An Update
The Constitutionality of the Affordable Care Act: An Update
The Court’s Holding
The Aftermath of the Ruling
References
Author Information

Content: States that challenged the ACA argued that the individual mandate was an overreach of Congress’s commerce clause powers, the government’s well-recognized (but not limitless) power to regulate certain economic activity that either occurs between states or substantially affects the states in the aggregate [6, 7]. The court reasoned that the commerce clause allows the government to regulate actions of those who participate in a market but not the inactions of those who choose not to participate in that market [8]. Without this distinction, the government could regulate practically anything. Justices analogized that, for example, persons with poor diets are pervasive and more costly to the health care system than the uninsured, yet it would be seen as a strong liberty breach for the government to mandate that citizens purchase only health food [8]. While the court rejected the claim that the individual mandate was within Congress’s commerce power, the mandate was found to be constitutional as a tax [9]. The penalty, though not labeled a tax in the ACA, is similar in several ways to other taxes. Its amount is determined by income, number of dependents, and filing status, and it is paid into the treasury when filing income tax. It is not a punishment for an illegal action: failure to purchase health insurance is not illegal, the penalty for refusing to purchase health insurance is less than the cost of paying for actual insurance, and there are no criminal sanctions attached. ( The Congressional Budget Office has predicted that approximately 4 million people will opt to pay the IRS instead of an insurance company [10].)