Is An Individual Health Insurance Mandate Constitutional ?

Over at Findlaw, Cornell University Law Professor Michael Dorf criticizes the libertarian argument that a government requirement that every citizen purchase health insurance is unconstitutional:

A federal statute that was already in effect in 1994 provides that “all citizens shall have . . . an obligation to serve as jurors when summoned for that purpose.” To be sure, the mechanisms used to assemble a pool of prospective jurors enable some people to slip through the cracks, but then, that surely would also be true of the individual mandate to obtain health insurance. No law can be perfectly enforced. The important point here is that jury duty, like draft registration, serves as a precedent for the imposition by the federal government of an affirmative duty on citizens.

The difference, of course, between a jury duty mandate or the draft and a law requiring every citizen to purchase health insurance is that both of these obligations of citizens predate the drafting of the Constitution and therefore it’s simply illogical to say that they are barred by the Constitution today, or that the Framer’s contemplated that in allowing the state to compel people to serve on juries, the were opening the door to a whole host of mandates that, if enforced would make freedom a mockery.

Since there doesn’t seem to be much precedent in Federal law, though, Dorf quickly moves on to state law:

Consider that states may impose an affirmative obligation of vaccination on residents. Even in an era when the Supreme Court was otherwise vigorously enforcing libertarian constitutional principles, in 1905, in Jacobson v. Massachusetts, the Court rejected a constitutional challenge to mandatory vaccination.If the government interest in public health is sufficient to overcome libertarian objections to injections into the very bodies of citizens, then surely the public health interest–which is, at bottom, what is at stake in the health insurance reform bills–should suffice to require Americans to buy health insurance or else pay a tax.

Again, it’s clear that Dorf makes the mistake here of finding an exception and turning into a rule. The important thing to note about Jacobson is that it dealt with mandatory vaccination of children for smallpox which was, until defeated by aggressive vaccination, a highly contagious, virulent disease with a high rate of mortality. Which there is a long argument on both sides of the mandatory vaccination issue, the argument in favor is certainly stronger when it involves combating the spread of a disease that poses such a severe risk to public health when balanced against the individual liberty interest in not getting vaccinated. It’s by no means clear, for example, that the result would be the same if the disease in question were something far less threatening to public health, like the seasonal flu.

Unless Dorf can make the argument that lack of health insurance poses an imminent threat to public health on a par with a smallpox epidemic, the Jacobson precedent would seem inapplicable.

The question of the Constitutionality of a health insurance mandate was addressed in a Washington Post Op-Ed by lawyers David Rivkin and Lee Casey and their argument bears repeating:

The Constitution assigns only limited, enumerated powers to Congress and none, including the power to regulate interstate commerce or to impose taxes, would support a federal mandate requiring anyone who is otherwise without health insurance to buy it.

Although the Supreme Court has interpreted Congress’s commerce power expansively, this type of mandate would not pass muster even under the most aggressive commerce clause cases. In Wickard v. Filburn (1942), the court upheld a federal law regulating the national wheat markets. The law was drawn so broadly that wheat grown for consumption on individual farms also was regulated. Even though this rule reached purely local (rather than interstate) activity, the court reasoned that the consumption of homegrown wheat by individual farms would, in the aggregate, have a substantial economic effect on interstate commerce, and so was within Congress’s reach.

The court reaffirmed this rationale in 2005 in Gonzales v. Raich, when it validated Congress’s authority to regulate the home cultivation of marijuana for personal use. In doing so, however, the justices emphasized that — as in the wheat case — “the activities regulated by the [Controlled Substances Act] are quintessentially economic.” That simply would not be true with regard to an individual health insurance mandate.

The otherwise uninsured would be required to buy coverage, not because they were even tangentially engaged in the “production, distribution or consumption of commodities,” but for no other reason than that people without health insurance exist. The federal government does not have the power to regulate Americans simply because they are there. Significantly, in two key cases, United States v. Lopez (1995) and United States v. Morrison (2000), the Supreme Court specifically rejected the proposition that the commerce clause allowed Congress to regulate noneconomic activities merely because, through a chain of causal effects, they might have an economic impact. These decisions reflect judicial recognition that the commerce clause is not infinitely elastic and that, by enumerating its powers, the framers denied Congress the type of general police power that is freely exercised by the states.

That’s the question that Dorf fails to answer — where in Article I Section 8 is Congress authorized to pass this mandate ?

The fact that he doesn’t address it suggests that there isn’t really an answer in the affirmative.

  • Roderick

    dorf says he’s going to address the art. sec 8 question in a followup column

  • http://www.belowthebeltway.com Doug Mataconis

    No, he says he’s going to address the federalism issue in the followup

    Different issue

  • http://www.belowthebeltway.com Doug Mataconis

    But, I’ll look for the follow up and respond to that as well

  • Mike

    I am a health insurance agent in Utah and run two websites that sell insurance http://www.benefitsmanager.net and http://www.dentalinsuranceutah.com. I mention this because in Utah it would be great to have a guaranteed public option to put people that the private insurers will decline for health conditions. Plus the way Weiner discribes the public option, it will be priced competitively. So what this means in my industry (I’ve been at it 18 years) is that all my unhealthy clients that get charged more or declined can be put onto the public option now. All my healthy clients can stay on the private option. Hmmmmm follow me yet???? How long can the public option stay affordable?? Who is going to pay for the losses of a big sick pool of people….taxpayers?????

  • Christopher

    Well considering there are states that prohibit a health provider from declining coverage due to a pre-existing condition, that doesn’t seem to be as penetrating a question as perhaps you’d like. The insurers in these states still post profits, are not in financial ruin, and are not seeking government assistance to help with the sustained cost of treating individuals who have a pre-existing condition.

  • http://thelibertypapers.org/ Quincy

    Christopher –

    Those states also feature health insurance that’s far, far more expensive than states without such regulations. The model is wholly unsustainable in the long term, as people can only pay so much in insurance premiums to subsidize others before they go broke.