Opinion ID: 223249
Heading Depth: 3
Heading Rank: 5

Heading: Broad Scope of Congress's Regulation

Text: The scope of Congress's regulation also affects the constitutional inquiry. Indisputably, the health insurance and health care industries involve, and substantially affect, interstate commerce, and Congress can regulate broadly in both those realms. Nonetheless, Congress, in exercising its commerce authority, must be careful not to sweep too broadly by including within the ambit of its regulation activities that bear an insufficient nexus with interstate commerce. See Morrison, 529 U.S. at 613 & n. 5, 120 S.Ct. at 1751-52 & n. 5 (distinguishing invalidated statute from analogous statute requiring explicit interstate nexus); Lopez, 514 U.S. at 561-62, 115 S.Ct. at 1631 (same). In this regard, the individual mandate's attempt to reduce the number of the uninsured and correct the cost-shifting problem is woefully overinclusive. The language of the mandate is not tied to those who do not pay for a portion of their health care ( i.e., the cost-shifters). It is not even tied to those who consume health care. Rather, the language of the mandate is unlimited, and covers even those who do not enter the health care market at all. Although overinclusiveness may not be fatal for constitutional purposes, the Supreme Court has indicated that it is a factor to be added to the constitutional equation. For example, in Lopez the vast majority of the regulated behavior (firearm possession) did possess an interstate character. [97] However, the Supreme Court ultimately found this fact insufficient to save the statute. Rather, the Supreme Court commented that an interstate-tying element in the statute itself would ensure, through case-by-case inquiry, that the [activity] in question affects interstate commerce. [98] Lopez, 514 U.S. at 561, 115 S.Ct. at 1631. Here, the decision to forego insurance similarly lacks an established interstate tie or any case-by-case inquiry. See id. Aside from the categories of exempted individuals, the individual mandate is applied across-the-board without regard to whether the regulated individuals receive, or have ever received, uncompensated careor, indeed, seek any care at all, either now or in the future. [99] Thus, the Act contains no language which might limit its reach to a discrete set of [activities] that additionally have an explicit connection with or effect on interstate commerce. See id. at 562, 115 S.Ct. at 1631. The individual mandate sweeps too broadly in another way. Because the Supreme Court's prior Commerce Clause cases all deal with already-existing activitynot the mere possibility of future activity (in this case, health care consumption) that could implicate interstate commercethe Court never had to address any temporal aspects of congressional regulation. However, the premise of the government's positionthat most people will, at some point in the future, consume health carereveals that the individual mandate is even further removed from traditional exercises of Congress's commerce power. [100] It is true that Congress may, in some instances, regulate individuals who are consuming health care but not themselves causing the cost-shifting problem. Cf. Raich, 545 U.S. at 17, 125 S.Ct. at 2206 (We have never required Congress to legislate with scientific exactitude.); id. at 22, 125 S.Ct. at 2209 (That the regulation ensnares some purely intrastate activity is of no moment.). As the plaintiffs acknowledged at oral argument, when the uninsured actually enter the stream of commerce and consume health care, Congress may regulate their activity at the point of consumption. But the individual mandate does not regulate behavior at the point of consumption. Indeed, the language of the individual mandate does not truly regulate how and when health care is paid for. 42 U.S.C. § 18091(a)(2)(A). It does not even require those who consume health care to pay for it with insurance when doing so. Instead, the language of the individual mandate in fact regulates a related, but different, subject matter: when health insurance is purchased. Id. If an individual's participation in the health care market is uncertain, their participation in the insurance market is even more so. In sum, the individual mandate is breathtaking in its expansive scope. It regulates those who have not entered the health care market at all. It regulates those who have entered the health care market, but have not entered the insurance market (and have no intention of doing so). It is overinclusive in when it regulates: it conflates those who presently consume health care with those who will not consume health care for many years into the future. The government's position amounts to an argument that the mere fact of an individual's existence substantially affects interstate commerce, and therefore Congress may regulate them at every point of their life. This theory affords no limiting principles in which to confine Congress's enumerated power.