Last month, the United States Supreme Court agreed to hear arguments on the constitutionality of the Patient Protection and Affordable Care Act (ACA), which President Obama signed into law in 2010 with the purpose of improving Americans’ access to health care. Legal challenges have focused primarily on the ACA’s individual mandate, which requires that most residents purchase qualified health plans or pay a fine, and the Medicaid expansion program, which expands Medicaid eligibility for residents to 133 percent of the federal poverty level.
Lower courts have split on whether the ACA is constitutional. See, e.g., Seven-Sky v. Holder, 2011 U.S. App. LEXIS 22566 (D.C. Cir. Nov. 8, 2011) (upholding the constitutionality of the ACA); Thomas More Law Ctr. v. Obama, 651 F.3d 529 (6th Cir. 2011) (upholding the constitutionality of the ACA); But see Florida v. Dep’t of Health & Human Servs., 648 F.3d 1235 (11th Cir. 2011) (holding that the Medicaid expansion program is constitutional because it is not unduly coercive, but striking down the individual mandate by finding it exceeds Congress’ authority under the Commerce Clause).
The Supreme Court will review four questions related to the constitutionality of the ACA: (1) whether the Anti-Injunction Act prevents lawsuits from challenging the individual mandate right now (if so, then the legal challenges cannot be in court until after the individual mandate goes into effect); (2) if the Anti-Injunction Act does not apply, is the individual mandate provision constitutional; (3) if the individual mandate is unconstitutional, can the rest of the ACA remain in effect without it; and (4) whether the ACA’s Medicaid expansion program is unconstitutional?
The Women’s Law Project believes that the ACA is a constitutional exercise of Congress’ broad powers under the Commerce and Spending Clauses of the United States Constitution. See, e.g., Wickard v. Filburn, 317 U.S. 111 (1942); Heart of Atlanta Motel v. United States, 379 U.S. 241 (1964); New York v. United States, 505 U.S. 144 (1992). The decision not to purchase health insurance is an economic activity subject to congressional regulation under the Commerce Clause because, over time, those uninsured individuals will impose costs on taxpayers and others when they inevitably utilize healthcare during the course of their lives. The Medicaid expansion program is also constitutional because it is a voluntary program that is not too coercive to the states. Even the 11th Circuit, which invalidated the individual mandate, held that the Medicaid expansion program is constitutional.
If the Supreme Court invalidates the ACA, the decision will jeopardize the health of millions of Americans. According to Media Matters, the law has already benefitted 4 million seniors with Medicare, 4 million small businesses, 2 million children, and 1 million young adults. The Herndon Alliance points out that, among other benefits, when the ACA is fully implemented “a child getting sick [would] no longer [be] a reason for a lifetime of denial of care [and] preventive services will give our children and our parents better chances for healthier and longer lives.”
In particular, women will suffer if the ACA is not upheld. The ACA benefits women in many ways, including by prohibiting insurers from using pregnancy, domestic violence, and sexual violence as “pre-existing conditions” to deny women health coverage, prohibiting the widespread practice of charging women higher insurance premiums than men for the same insurance (known as gender rating), guaranteeing maternity coverage, and ensuring new plans cover preventative services such as Pap smears and mammograms.
The ACA is constitutional and vitally important to improving the health of American citizens, particularly women. The WLP strives to eliminate sex discrimination in insurance and to expand health coverage, and full implementation of the ACA is essential to meeting these goals. For more information on the ACA and WLP’s work on access to health care, see WLP Health Care Reform.