Opinion ID: 2427342
Heading Depth: 1
Heading Rank: 5

Heading: Whether the Minimum Coverage Provision Impermissibly Regulates Inactivity

Text: Thomas More argues that the minimum coverage provision exceeds Congress's power under the Commerce Clause because it regulates inactivity. However, the text of the Commerce Clause does not acknowledge a constitutional distinction between activity and inactivity, and neither does the Supreme Court. Furthermore, far from regulating inactivity, the provision regulates active participation in the health care market. As long as Congress does not exceed the established limits of its Commerce Power, there is no constitutional impediment to enacting legislation that could be characterized as regulating inactivity. The Supreme Court has never directly addressed whether Congress may use its Commerce Clause power to regulate inactivity, and it has not defined activity or inactivity in this context. However, it has eschewed defining the scope of the Commerce Power by reference to flexible labels, and it consistently stresses that Congress's authority to legislate under this grant of power is informed by broad principles of economic practicality. Lopez, 514 U.S. at 571, 115 S.Ct. 1624 (Kennedy, J., concurring); see Wickard, 317 U.S. at 120, 63 S.Ct. 82 (explaining that Congress's power cannot be determined by reference to any formula which would give controlling force to nomenclature such as `production' and `indirect' and foreclose consideration of the actual effects of the activity in question upon interstate commerce). Similarly, this Court has also refused to focus on imprecise labels when determining whether a statute falls within Congress's Commerce Power. For example, we rejected the argument that the Child Support Recovery Act is unconstitutional because it regulates an individual's failure to place an item in commerce. Instead, we held that Congress had a rational basis for concluding that a non-custodial spouse's failure to send court-ordered child support payments across state lines substantially affects interstate commerce. Faasse, 265 F.3d at 490-91; accord United States v. Black, 125 F.3d 454, 462 (7th Cir.1997); United States v. Parker, 108 F.3d 28, 30 (3d Cir.1997); United States v. Hampshire, 95 F.3d 999, 1004 (10th Cir.1996). Focusing on the broader economic landscape of the legislation revealed the unworkability of relying on inexact labels because there was no principled distinction between the parent who fails to send any child support through commerce and the parent who sends only a fraction of the amount owed. Faasse, 265 F.3d at 487 n. 9. Here, too, the constitutionality of the minimum coverage provision cannot be resolved with a myopic focus on a malleable label. Congress had a rational basis for concluding that the practice of self-insuring for the cost of health care has a substantial effect on interstate commerce, and that the minimum coverage provision is an essential part of a broader economic regulatory scheme. Thus, the provision is constitutional notwithstanding the fact that it could be labeled as regulating inactivity. Furthermore, far from regulating inactivity, the minimum coverage provision regulates individuals who are, in the aggregate, active in the health care market. The Supreme Court has stated that when it is necessary in order to prevent an evil to make the law embrace more than the precise thing to be prevented [Congress] may do so. Westfall v. United States, 274 U.S. 256, 259, 47 S.Ct. 629, 71 L.Ed. 1036 (1927). The vast majority of individuals are active in the market for health care delivery because of two unique characteristics of this market: (1) virtually everyone requires health care services at some unpredictable point; and (2) individuals receive health care services regardless of ability to pay. Virtually everyone will need health care services at some point, including, in the aggregate, those without health insurance. Even dramatic attempts to protect one's health and minimize the need for health care will not always be successful, and the health care market is characterized by unpredictable and unavoidable needs for care. The ubiquity and unpredictability of the need for medical care is born out by the statistics. More than eighty percent of adults nationwide visited a doctor or other health care professional one or more times in 2009. Centers for Disease Control and Prevention National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009, table 35 (2010). Additionally, individuals receive health care services regardless of whether they can afford the treatment. The obligation to provide treatment regardless of ability to pay is imposed by the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd, state laws, and many institutions' charitable missions. The unavoidable need for health care coupled with the obligation to provide treatment make it virtually certain that all individuals will require and receive health care at some point. Thus, although there is no firm, constitutional bar that prohibits Congress from placing regulations on what could be described as inactivity, even if there were it would not impact this case due to the unique aspects of health care that make all individuals active in this market.
In light of the conclusion that the minimum coverage provision is a valid exercise of Congress's power under the Commerce Clause, it is not necessary to resolve whether the provision could also be sustained as a proper exercise of Congress's power to tax and spend under the General Welfare Clause, U.S. Const. Art. I, § 8, cl. 1.
Congress had a rational basis for concluding that, in the aggregate, the practice of self-insuring for the cost of health care substantially affects interstate commerce. Furthermore, Congress had a rational basis for concluding that the minimum coverage provision is essential to the Affordable Care Act's larger reforms to the national markets in health care delivery and health insurance. Finally, the provision regulates active participation in the health care market, and in any case, the Constitution imposes no categorical bar on regulating inactivity. Thus, the minimum coverage provision is a valid exercise of Congress's authority under the Commerce Clause, and the decision of the district court is AFFIRMED.