Guest Blog by Alex Cotoia: Supreme Court’s Ruling on the Constitutionality of the ACA

Alexander Cotoia is a paralegal with the firm of Holt Mynatt Martinez P.C. in Las Cruces, and a member of the Democratic Party State Central Committee.  He has authored several guest columns that have appeared on this site.

In a matter of days, the U.S. Supreme Court will weigh in on the future of the Patient Protection and Affordable Care Act (“ACA”), as it issues its much anticipated decision governing the constitutionality of the law under the federal Constitution. Exhaustively discussed in legal and political circles, the ACA contains a number of controversial provisions, including the hotly contested “individual mandate” or “minimum coverage provision” that conservatives view as anathema; an impermissible encroachment on an individual’s economic liberty.

If the Court were to accept this argument and strike down the ACA or any portion of the Act as constitutionally incompatible, it would be engaging in an egregious act of judicial activism; upending the principle of congressional deference and subverting the justification for “rational basis” review, which long recognized that Congress possesses plenary, or exclusive power over the regulation of interstate commerce. As Justice Breyer noted in dissent in the landmark case of U.S. v. Lopez—the seminal case in which the Court departed from nearly a half century of settled jurisprudence—the Court’s function is to assess “not whether the regulated activity sufficiently affected interstate commerce, but, rather, whether Congress could have had a rational basis for so concluding.”

That a rational basis exists for regulating the health insurance market is beyond legitimate contention. The unique nature of American health care, coupled with the inability of an individual to opt out (even those with the strongest immune systems are likely to fall ill at least once during their lifespan) left Congress little choice but to fashion legislation that included a minimum coverage provision to curb skyrocketing health care costs, and eradicate the ‘cost-shifting’ that is largely responsible for escalating premiums. Far from being without precedent, this is exactly the kind of “broader regulatory scheme” that the Supreme Court has consistently deemed constitutionally permissible, even in cases where the regulated activity was of a “wholly intrastate [and] . . . non-economic” character. (For a more detailed discussion about Commerce Clause jurisprudence, see opinion by a federal judge upholding the constitutionality of the ACA here: https://www.hfma.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=24259)

I’m not saying the ACA is perfect—it isn’t. In a world in which the United States stands alone among our industrialized counterparts in providing health care as a matter of right to its citizens, the better, but far more controversial option would have been to expand Medicare and eliminate the private insurance market altogether. But this President recognizes political reality, and chose to pass legislation that dramatically expanded health care coverage to uninsured Americans; banned discrimination based on pre-existing conditions; and required insurance companies to cover a host of preventative care services without requiring a co-payment from the consumer. On balance, the ACA is a positive first-step in recognizing that access to quality, affordable health care is an integral part of American competitiveness. If Americans are to have an edge with our competitors the world over, it is imperative that we live both productive and healthy lives.

For this reason, the Court would do well to reject the frenzied contentions of the reactionary right and give new meaning to the principle of stare decisis. Allowing the ACA to stand is both legally sound and practically expedient. If conservatives truly were champions of judicial restraint, they would agree.