Prescribing a healthy debate

Kayla Oliver

March 28 marked the end of oral arguments at the Supreme Court over the constitutionality of the 2010 Affordable Care Act. The lawsuit filed by Texas and 25 other states questions the legality of several of the act’s provisions, including the individual mandate — a stipulation that would require most Americans to purchase health insurance — and the expansion of the Medicaid system. Although deliberation has already begun behind closed doors, the court is not expected to release its decisions until this summer.

The case’s outcome holds serious consequences. Though neither attorneys nor judges mentioned President Barack Obama’s name during the oral arguments, it is tacitly acknowledged that the outcome of November’s presidential election rests in part on the court’s ruling. Obama has built much of his political clout on the Affordable Care Act, and the degree to which his ideas are implemented is sure to color his legacy as president.

The court’s decision will also affect college students, who, under the Affordable Care Act, would be allowed to stay on their parents’ insurance plan until age 26. This would allow them to defer worries about health insurance until a few years after college and would free them from the pressure to accept their first job offer out of a need for medical coverage. In addition, the government-sponsored insurance plans would cover preventive care such as cancer screenings and checkups and would not discriminate against those with preexisting conditions.

Still, the provision of quality health care for all Americans should not come at the expense of our Constitution. The court’s task — and the task that all politically responsible Americans should attempt — is to separate ideology from legality.

First, and almost comically, the court must decide whether to honor the Anti-Injunction Act of 1876, a rather obscure rule that blocks lawsuits against a tax before that tax has been paid. If the court upholds the act, the lawsuit will be thrown out altogether since the tax in question — the penalty for Americans who do not purchase health insurance — will not be levied until 2014. However, it appears that in this case the justices will ignore or skirt around the Anti-Injunction Act.

The court must also address the Affordable Care Act’s most contentious tenet, the individual mandate to purchase health insurance. The act’s defenders claim that the mandate falls within the scope of federal power under the commerce clause, which gives Congress the power to regulate interstate trade. Since health insurance interactions frequently cross state boundaries, it seems reasonable to cite health care as an instance of interstate commerce governable under the Constitution. Critics, on the other hand, find the mandate an unconstitutional extension of federal power. Judging by the amount of time the court devoted to arguments over the mandate, there is a real chance that several of the justices — particularly the court’s five conservatives — will deem it unconstitutional.

Finally, the states that filed the suit claim that the act’s threat that states must accept a Medicaid expansion program or lose all of their Medicaid funding amounts to coercion.

However, those states have conveniently ignored the fact that “the federal government … expanded Medicaid several times in the past 30 years under the same exact terms with no constitutional objections from the states,” an argument the liberal justices made many times, according to Forbes.

This recent conservative anxiety over the alleged aggression of the federal government may help explain the vehement opposition to the individual mandate as well.

Considering this precedent, it is unlikely that the court will rule against the Medicaid expansion. However, if it finds the individual mandate unconstitutional, the justices must then decide if the act can stand without the mandate. This question of “severability” has met with various responses among the justices, but it is clear that an act aiming to provide universal health care would be crippled without the provision that mandates the universal purchase of that care.

The justices are sure to reach differing decisions that will be complex and contradictory, but the ultimate fate of the Affordable Care Act has financial and medical implications for all Americans. Now that the health care debate has reached the nation’s highest court, it is time for us all to temporarily shelve ideological arguments in favor of a rational discussion of the act’s constitutionality.

Oliver is an English and sociology freshman.