Third Federal Judge Upholds Constitutionality of Affordable Care Act

On February 22, a federal district judge in the District of Columbia became the third federal judge to affirm constitutionality of the Patient Protection and Affordable Care Act, making the national scorecard 3-2 rulings in favor.

Judge Gladys Kessler dismissed the challenge to the individual mandate clause filed by five individuals representing the American Center for Law and Justice, a conservative legal group. The group argued that it is unconstitutional to require individuals to purchase health insurance and also claimed that the mandate is in conflict with their religious freedoms.

In her 64-page opinion, Judge Kessler "didn't mince words," writes Jonathan Cohn, health care writer and editor of the New Republic. The judge stated that the claim the law regulates "inactivity" is nothing more than semantics, saying:

"It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not ‘acting,’ especially given the serious economic and health-related consequences to every individual of that choice. Making a choice is an affirmative action, whether one decides to do something or not do something. They are two sides of the same coin. To pretend otherwise is to ignore reality.”To date, three judges have upheld the law, thirteen federal district judges rejected lawsuits charging that the Affordable Care Act is unconstitutional, and two have ruled against it.

Judge Kessler also points out the decision to not obtain health insurance results in higher premiums for all those who do pay for coverage. Her ruling upholds the model of individual responsibility that is vital to the Affordable Care Act. It is incorrect to think that individuals, even those without insurance, are not already in the health care marketplace. They are.

In addition, Judge Kessler takes a strong stance against the "broccoli argument" posed by Judges Henry Hudson and Roger Vinson, who both ruled again the ACA. If Congress can make you purchase health insurance, they argue, why can't it make you buy broccoli or a certain kind of car? Kessler responds:

"This second aspect of the health care market distinguishes the ACA from Plaintiffs’ hypothetical scenario in which Congress enacts a law requiring individuals to purchase automobiles in an attempt to regulate the transportation market. Even assuming that all individuals require transportation in the same sense that all individuals require medical services, automobile manufacturers are not required by law to give cars to people who show up at their door in need of transportation but without the money to pay for it. Similarly, food and lodging are basic necessities, but the Court is not aware of any law requiring restaurants or hotels to provide either free of charge."

In short, she recognized that the insurance market is much different than other kinds of markets, and that the rules governing them must be adjusted accordingly. This is "critical to understanding the ACA’s efforts to reform the health care system," writes Cohn. "The requirement placed upon medical providers by federal law to care for the sick and injured without recompense is part of the cost-shifting problem that Congress sought to redress by enacting the ACA. When a supplier is obligated by law to produce goods or services for free, there is bound to be a substantial effect on market prices if consumers’ behavior results in that obligation’s frequent invocation."

The Affordable Care Act has already made a difference in the lives of millions of Illinoisans. Over 2.5 million state residents under the age of 65 who have pre-existing conditions will now be able to get health insurance. All of Illinois’s 1,770,000 seniors and people with disabilities on Medicare will no longer have to pay for preventive services, and many will have more help paying for prescriptions. In total, 1,163,000 uninsured Illinoisans will gain insurance coverage.

"Health care is the key to economic security and opportunity, and the Affordable Care Act is finally bringing fairness to the health care system for American families,” says Jim Duffett, executive director of Campaign for Better Health Care.

To date, three judges have upheld the law, thirteen federal district judges rejected lawsuits charging that the Affordable Care Act is unconstitutional, and two have ruled against it.

-- Kathleen Duffy, Campaign for Better Health Care