February 1, 2011

Fla. Health Care Decision Reads Crucial Clause out of Constitution

Adam Winkler, Affordable Care Act, Health Care Reform, individual mandate, McCulloch v. Maryland, Necessary & Proper Clause

By Adam Winkler, a constitutional law professor at UCLA School of Law. 

Judge Vinson's opinion striking down the Affordable Care Act was remarkable for the ease with which it jettisoned two centuries of settled law. Ever since McCulloch v. Maryland, the Supreme Court has held that the Necessary and Proper Clause gives Congress the authority to reach matters otherwise beyond the strict confines of Congress's enumerated powers. Yet Judge Vinson - like Judge Hudson in the Virginia decision several weeks ago - effectively reads the Necessary and Proper Clause out of the Constitution.

Vinson's logic goes like this. The minimum insurance requirement, he says, falls outside of Congress's power to regulate "commerce . . . among the several states" because it regulates inactivity, rather than activity. Of course, nowhere in the text of the Constitution is Congress's authority limited to regulating activity, but ignore that for the moment. Because Congress doesn't have power under the Commerce Clause to require taxpayers to purchase insurance, the Necessary and Proper Clause can't be used to justify the law either.

The judge's decision can't deny that the insurance requirement is necessary. Indeed, it is so central to this comprehensive health insurance regulation that he held the whole law had to be struck down. The problem, he says, is that the minimum coverage provision isn't "proper" because it falls outside of Congress's powers under the Commerce Clause.

If Vinson's tautology were applied to past Necessary and Proper Clause cases, they would come out the other way. In McCulloch, the law chartering a federal bank would be invalidated because Congress doesn't have any explicit power to charter a bank. In Gonzales v. Raich the Court upheld a federal ban on homegrown marijuana because, Justice Scalia's influential concurring opinion explained, it was an essential piece of a comprehensive regulation of a market - even though the growing of marijuana for personal use was beyond the reach of the Commerce Clause. Vinson's reasoning would mandate the opposite result. And just last term, the Supreme Court held in United States v. Comstock that the Necessary and Proper Clause empowered Congress to detain certain sex offenders even though, again, doing so was outside of any other enumerated powers.

The basic purpose of the Necessary and Proper Clause is to give Congress the choice of means it can use to make a regulation of, say, interstate commerce effective. That is exactly what the minimum coverage requirement does. There's no doubt that the Affordable Care Act is a broad, comprehensive regulation of the health insurance market. Requiring individuals to finance their own medical expenses is closely and directly tied to the viability of that broader regulation. That's why it is both necessary and proper, however those terms are defined.