The mandate is constitutional under the commerce clause

Congress has ample power and precedent through the Constitution’s “Commerce Clause” to regulate just about any aspect of the national economy. Health insurance is quintessentially an economic good. The only possible objection is that mandating its purchase is not the same as “regulating” its purchase, but a mandate is just a stronger form of regulation. Where a Congressional power exists, nothing in law says that ”strong” and potentially more intrusive forms of action are less supported than weaker ones.(11) Critics of an individual mandate cite recent Supreme Court cases in which the Court has limited the commerce clause’s power. However, those cases (Lopez and Morrison) involved regulation of non-economic activity. The individual mandate regulates the relationship between sellers and buyers of health care insurance. Moreover, the Court was concerned in Lopez and Morrison with efforts by Congress to intrude into areas that are properly regulated by state governments and thereby to upset the balance of power between the federal and state governments. By contrast, congressional regulation of the health care industry does not violate state prerogatives. To be sure, much regulation of insurance occurs at the state level, but that is because Congress has chosen by statute to defer to state regulation. The Constitution does not prevent Congress from revoking its statutory grants to state governments.(12) Those who argue that this is unconstitutional maintain that those not purchasing health insurance, by definition, are not part of interstate commerce. There are numerous flaws with this argument. First, Congress can regulate activities that themselves are not part of interstate commerce if they have a substantial effect on interstate commerce. For example, in Wickard v. Filburn, the Supreme Court held that Congress could regulate wheat that farmers grew for their own home consumption. More recently in Gonzales v. Raich, the Court ruled that Congress could prohibit cultivating and possessing small amounts of marijuana for personal medicinal use. Even though the individuals were not personally engaged in commerce, the matter still fit within the commerce power.(10) Second, the decision to abstain from particular economic transactions is a form of commercial behaviour that Congress can regulate. The Supreme Court held that Congress could require that hotels and restaurants provide services to African-Americans. Their refusal to engage in commerce still was deemed to be within the scope of Congress's commerce clause power.(10) This is made more significant by the fact that the decision to remain uninsured can affect commerce- both within and between states- by raising health insurance premiums. This is because insurance premiums tend to rise in response to reductions in the size of the pool of individuals to whom financial risk can be distributed.(14) Citizens who forego health insurance are forcing other Americans to cover their costs if they are sent to hospital for emergency treatment. They are also forcing others to pay higher insurance rates, now that insurance companies can no longer legally exclude those with pre-existing conditions.(15) Third, the likelihood is that everyone will require medical care at some point. An uninsured person in a car accident will be taken to the emergency room for treatment. An uninsured person with a communicable disease will be treated. Congress can ensure that there is an adequate fund to pay for everyone's medical needs. In other words, the health care system is part of interstate commerce. Providing care for all unquestionably has a substantial economic effect. Congress, then, can use its authority under the necessary and proper clause to make sure that the system that it is creating is viable and capable of providing health care for all.(10) Therefore the individual healthcare mandate is constitutional because it is authorized under the commerce clause of the constitution.