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White House Issues First Legal Defense of Healthcare Reform

Elyas Bakhtiari, for HealthLeaders Media, May 14, 2010

White House lawyers have filed the government's response to a lawsuit seeking to overturn the Patient Protection and Affordable Care Act, previewing what may become a state-by-state legal battle over the future of healthcare reform.

The suit was filed by the Thomas More Law Center in the U.S. District Court for the Eastern District of Michigan on behalf of four uninsured individuals who do not plan to buy health insurance and claim they will be harmed by the monetary penalty when insurance becomes mandatory in 2014. The suit asserts that the requirement and penalty are unconstitutional and seeks to overturn the law.

However, the White House issued a two-pronged defense this week.

First, the administration argued that the individuals don't have grounds for the suit because they have not suffered actual or imminent injury from the law. Any harm to the plaintiffs is "speculative and, in any event, reparable," the lawyers said, and they provided examples in which the penalties might not apply to the individuals. They could find insurance through employment between now and 2014, for instance, or may qualify for some of the available exemptions or subsidies under the law.

The second argument was broader and may indicate how the government will defend the law's constitutionality in other cases.

The administration said the individual mandate falls under Congress' authority granted by the Constitution to regulate interstate commerce and its power to tax and spend to provide for the general welfare of the United States.

Individuals who decide to forgo insurance still often receive treatment or utilize health services, shifting the cost of care to a third party--state and local governments, healthcare providers, insures, and the insured population. The administration said in its response that because this cost shifting affects people and companies in other states, the individual mandate provision is an exercise of Congress' authority over interstate commerce.

The debate over the individual mandate's constitutionality may make it all the way to the Supreme Court, through one of the dozens of other lawsuits if not the Michigan case. Seven more states have joined a lawsuit originally filed by Florida, bringing the total of state attorneys general challenging the new law up to 20, the Washington Post reports.

The state lawsuits may provide for more complicated arguments, as some states have passed laws prohibiting the individual mandate and others are considering constitutional amendments along the same lines.

In its brief, the administration defended the mandate as being essential to success of the overall reform effort.

"After decades of failed attempts, Congress enacted comprehensive healthcare reform to deal with this overwhelming national problem. The minimum coverage provision is vital to that comprehensive scheme. Enjoining it would thwart this reform and re-ignite the crisis that the elected branches of government acted to forestall."


Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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