Health Reform

In this excellent and readable brief from the Kaiser Foundation, the issues being considered by the Supreme Court to those challenging reform are detailed.  The two major Constitutional issues concern: 1) the individual mandate, the requirement that all be insured and 2) the Medicaid expansion which requires all states to cover all people under 138% of the federal poverty line in their state Medicaid programs.

The main issue for the individual mandate is whether or not the mandate violates the Commerce Clause of the Constitution.  Requiring the purchase of insurance is considered by the plaintiffs to be outside of the authority of Congress because the federal government does not have authority to compel people to enter any commercial activity.  Further, taxing authority is called into questions related to the penalties/fines associated with not being insured.  There is disagreement as to whether the current set up of collecting fines for non-compliance through the tax system oversteps Congress’s power to tax.

The main issue for the Medicaid expansion is whether or not it the mandatory coverage criteria coerces states to participate in Medicaid.  Currently all states do participate in Medicaid (that has not always been true) but it is a voluntary federal-state partnership.  When states participate, they are always bound by federal rules governing how they can set up Medicaid.