Title: 
Headings: Health Care: Constitutional Rights and Legislative Powers
Health
 
Care:
 
Constitutional
 
Rights
 
and
 
Legislative
 
Powers
 

Kathleen
 
S.
 
Swendiman
 

CRS
 
Report
 
for
 
Congress

Congressional
 
Research
 
Service
 

Summary
 

Health
 
Care
 
Rights
 
Under
 
the
 
U.S.
 
Constitution
 

Explicit
 
Rights
 
in
 
the
 
U.S.
 
Constitution
 

The
 
Right
 
to
 
Health
 
Care
 
at
 
the
 
Government’s
 
Expense
 

Substantive
 
Due
 
Process:
 
Impact
 
on
 
Fundamental
 
Rights
 

Equal
 
Protection:
 
Wealth
 
as
 
a
 
“Suspect
 
Class”
 

Exception:
 
Under
 
Government
 
Control
 

Health
 
Care
 
Legislation
 
Under
 
the
 
U.S.
 
Constitution
 

Specific
 
Sources
 
of
 
Constitutional
 
Authority
 

The
 
Power
 
to
 
Tax
 
and
 
Spend
 
for
 
the
 
General
 
Welfare
 

The
 
Power
 
To
 
Regulate
 
Interstate
 
Commerce
 

Federal
 
Health
 
Care
 
Programs
 

The
 
Affordable
 
Care
 
Act
 

Supreme
 
Court
 
Decision
 
in
 
National
 
Federation
 
of
 
Independent
 
Business
 
v.
 
Sebelius
 

State
 
Attempts
 
to
 
“Nullify”
 
or
 
“Opt
 
Out”
 
of
 
Affordable
 
Care
 
Act
 
Requirements
 

State
 
statutes
 
and
 
constitutional
 
amendments
 

Interstate
 
compacts
 

State
 
Constitutions
 
and
 
the
 
Provision
 
of
 
Health
 
Care
 
Services
 

Author
 
Contact
 
Information
 


Content: The
 
United
 
States
 
Supreme
 
Court’s
 
decision
 
in
 
NFIB
 
v.
 
Sebelius,
 
which
 
upheld
 
most
 
of
 
the
 
Patient
 
Protection
 
and
 
Affordable
 
Care
 
Act
 
(Affordable
 
Care
 
Act/ACA),
 
is
 
also
 
discussed. The
 
United
 
States
 
Constitution
 
does
 
not
 
set
 
forth
 
an
 
explicit
 
right
 
to
 
health
 
care,
 
and
 
the
 
Supreme
 
Court
 
has
 
never
 
interpreted
 
the
 
Constitution
 
as
 
guaranteeing
 
a
 
right
 
to
 
health
 
care
 
services
 
from
 
the
 
government
 
for
 
those
 
who
 
cannot
 
afford
 
it. The
 
Supreme
 
Court
 
has,
 
however,
 
held
 
that
 
the
 
government
 
has
 
an
 
obligation
 
to
 
provide
 
medical
 
care
 
in
 
certain
 
limited
 
circumstances,
 
such
 
as
 
for
 
prisoners. Congress
 
has
 
enacted
 
numerous
 
statutes,
 
such
 
as
 
Medicare,
 
Medicaid,
 
and
 
the
 
Children’s
 
Health
 
Insurance
 
Program,
 
that
 
establish
 
and
 
define
 
specific
 
statutory
 
rights
 
of
 
individuals
 
to
 
receive
 
health
 
care
 
services
 
from
 
the
 
government. As
 
a
 
major
 
component
 
of
 
many
 
health
 
care
 
entitlement
 
statutes,
 
Congress
 
has
 
provided
 
funding
 
to
 
pay
 
for
 
the
 
health
 
services
 
provided
 
under
 
law. Most
 
of
 
these
 
statutes
 
have
 
been
 
enacted
 
pursuant
 
to
 
Congress’s
 
authority
 
to
 
“make
 
all
 
Laws
 
which
 
shall
 
be
 
necessary
 
and
 
proper”
 
to
 
carry
 
out
 
its
 
mandate
 
“to
 
…
 
provide
 
for
 
the
 
…
 
general
 
Welfare.” Congress
 
has
 
also
 
used
 
other
 
constitutional
 
powers,
 
such
 
as
 
its
 
power
 
to
 
regulate
 
interstate
 
commerce
 
and
 
its
 
power
 
to
 
levy
 
taxes,
 
to
 
enact
 
legislation
 
relating
 
to
 
health
 
insurance
 
and
 
health
 
care. In
 
2010,
 
Congress
 
enacted
 
the
 
Affordable
 
Care
 
Act,
 
a
 
comprehensive
 
health
 
care
 
reform
 
law
 
which
 
includes
 
a
 
requirement,
 
effective
 
in
 
2014,
 
that
 
most
 
individuals
 
purchase
 
health
 
insurance,
 
and
 
which
 
significantly
 
expands
 
the
 
Medicaid
 
program. A
 
number
 
of
 
lawsuits
 
were
 
filed
 
challenging
 
various
 
provisions
 
of
 
this
 
legislation,
 
and,
 
on
 
June
 
28,
 
2012,
 
the
 
Supreme
 
Court
 
upheld
 
the
 
majority
 
of
 
ACA’s
 
provisions. Significantly,
 
the
 
Court
 
upheld
 
the
 
requirement
 
that
 
individuals
 
purchase
 
health
 
insurance
 
as
 
a
 
valid
 
exercise
 
of
 
Congress’
 
taxing
 
power,
 
but
 
the
 
Court
 
limited
 
Congress’
 
power
 
to
 
spend
 
for
 
the
 
general
 
welfare
 
by
 
holding
 
that
 
Congress
 
cannot
 
threaten
 
the
 
states
 
with
 
the
 
loss
 
of
 
all
 
federal
 
Medicaid
 
funds
 
if
 
the
 
states
 
decline
 
to
 
expand
 
Medicaid
 
coverage
 
as
 
mandated
 
by
 
ACA.