David Rivkin Jr. and Lee A. Casey, two very conservative partners (see sample of their writings following this article) at the law firm Baker Hostetler LLP, have co-authored an op-ed in the Washington Post that attempts to challenge the constitutionality of pending healthcare reform legislation. Specifically, Rivkin and Casey argue that Congress lacks the authority to require everyone (with a few exceptions) to have health insurance. Rivkin and Casey argue that neither the Commerce Power nor the power to "tax" authorizes Congress to mandate universal coverage.
The Commerce Clause authorizes Congress to regulate commerce with "foreign nations," "Indian tribes," and "among the several states." As Rivkin and Casey acknowledge, for six decades beginning in the 1930s, the Supreme Court interpreted the Commerce Power quite expansively. During that time it became a major source of power authorizing the enactment of measures as diverse as federal criminal laws, environmental laws, labor laws, securities laws and civil rights. The Rehnquist revolution, however, has led to a conservative shift (the degree of which is debatable) in the Court's interpretation of the Commerce Power.
Although the Court has seemingly shifted to a more restrictive analysis of the Commerce Clause, it has not completely abandoned showing deference and flexibility to Congress. In the 2005 Gonzales v. Raich decision, the Court upheld Congress' authority to regulate the "intrastate, noncommercial cultivation, possession and use of marijuana."
Rivkin and Casey argue that Raich cannot justify the individual insurance mandate because the Court found that the Controlled Substance Act (CSA) regulates "economic" activity, while a mandate to enroll in a health plan does not. There are two serious problems with this argument: It misreads Raich, and it fails to recognize the economic impact of uninsured people on the medical services and health insurance markets.
Requiring Health Insurance = Prohibiting Use of Medical Marijuana?
In Raich, the Supreme Court held that Congress could regulate the intrastate use or possession of medical marijuana for three reasons. First, the CSA represents a valid exercise of the Commerce Power because the statute "regulates the production, distribution, and consumption of commodities for which there is an established, and lucrative, interstate market." Second, considered in the aggregate, the use or possession of medical marijuana substantially affects interstate commerce because it increases the availability of marijuana in the nonmedical and interstate markets. Third, regulating the use or possession of medical marijuana is "an essential part of the larger regulatory scheme" accomplished by the CSA.
Justice Scalia wrote separately, concurring in the judgment, and he based his arguments exclusively on the fact that the marijuana prohibition is part of a broader commercial regulation (the CSA). Only two justices (O'Connor and Thomas) dissented.
Raich could indeed justify the insurance mandate. The proposed reforms seek to reduce costs, inefficiencies and inaccessibility in the health insurance and medical services markets. These markets are inherently interstate and commercial. Caring for uninsured persons unduly increases the costs associated with health insurance and medical services and diminishes access and coverage for consumers who desire these services. Finally, requiring universal coverage is an essential part of the Congressional scheme designed to lower costs and expand access in health insurance and medical services markets.
Although the Constitution gives Congress the power to "tax" and to "spend" in the general welfare of the country, Rivkin and Casey argue that the Tax Power cannot justify mandatory coverage because Congress cannot use this power to circumvent the constraints imposed by the Constitution. To support this argument, Rivkin and Casey reached deeply into the vault and retrieved the 1922 case Bailey v. Drexel Furniture. In that case, the Court invalidated a 10% tax on the profits of companies that used child labor. The Court held that even though the Tax Power is very broad, Congress could not use it as a pretext to accomplish an otherwise unconstitutional end. There are major differences between Drexel Furniture and proposed healthcare reform.
First, in Hamer v. Dagenhart, decided just 4 years prior to Drexel Furniture, the Court explicitly invalidated a federal law that banned the use of child labor. Because the Court had so recently held that Congress could not prohibit child labor, it was easy to view the onerous tax in Drexel Furniture as an improper attempt to evade prior case law.
Over time, the Court has expanded the scope of the Commerce Power and explicitly overruled Dagenhart. This same doctrinal evolution authorizes Congress to mandate individual coverage. Clearly, if Congress can mandate coverage under the Commerce Power, then taxing or imposing a penalty upon individuals who fail to pay would not contradict Drexel Furniture.
On some level, I agree with Rivkin and Casey who argue that raising taxes and funding "universal care" (rather than mandating universal coverage) would provide a "neater" solution to these issues. But this is not a politically popular solution. The fact that a cleaner solution exists, however, does not make the one that Congress has proposed unconstitutional. The current case law permits Congress to regulate health insurance and medical services markets. Requiring universal coverage is an essential component of that broader regulatory effort.
Note: Jonathan Adler, writing for the Volokh Conspiracy, has a similar take:
While I agree that the recent commerce clause cases hold that Congress may not regulate noneconomic activity, as such, they also state that Congress may reach otherwise unregulable conduct as part of an overarching regulatory scheme, where the regulation of such conduct is necessary and proper to the success of such scheme. In this case, the overall scheme would involve the regulation of "commerce" as the Supreme Court has defined it for several decades, as it would involve the regulation of health care markets. And the success of such a regulatory scheme would depend upon requiring all to participate. (Among other things, if health care reform requires insurers to issue insurance to all comers, and prohibits refusals for pre-existing conditions, then a mandate is necessary to prevent opportunistic behavior by individuals who simply wait to purchase insurance until they get sick.)Note: My essay only addresses the Congressional authority claim. Whether some individuals could successfully assert an individual right against the mandate is a different question. Because the mandate operates like a tax, it is difficult to imagine a successful "rights" claim.
Note: Speaking of "wrong," look at this essay by the same duo: David B. Rivkin Jr. & Lee A. Casey on Amnesty International on National Review Online.
Or this nugget: Tortured Logic on Torture.
Despite all of the evidence to the contrary, Rivkin and Casey still deny that the Bush administration engaged in torture: The Memos Prove We Didn't Torture - WSJ.com.