{ "id": "R40725", "type": "CRS Report", "typeId": "REPORTS", "number": "R40725", "active": false, "source": "EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source": "EveryCRSReport.com", "id": 405688, "date": "2012-04-06", "retrieved": "2016-04-07T00:09:31.647768", "title": "Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis", "summary": "As part of the Patient Protection and Affordable Care Act (ACA), P.L. 111-148, as amended, Congress enacted a \u201cminimum coverage provision,\u201d which compels certain individuals to have a minimum level of health insurance (i.e., an \u201cindividual mandate\u201d). Individuals who fail to do so may be subject to a monetary penalty, administered through the tax code. Congress has never compelled individuals to buy health insurance, and there has been significant controversy and debate over whether the requirement is within the scope of Congress\u2019s legislative powers.\nShortly after ACA was enacted, several lawsuits were filed that challenge the individual mandate on constitutional grounds. While some of these cases have been dismissed for procedural reasons, others have moved forward. These challenges have now reached the Supreme Court. During the last week of March, the Court heard arguments in HHS v. Florida, a case in which attorneys general and governors in 26 states as well as others brought an action against the Administration, seeking to invalidate the individual mandate and other provisions of ACA. Besides evaluating the constitutionality of the individual mandate, the Court is examining the question of whether the Anti-Injunction Act currently prevents the Court from ruling on the merits of the case. It also is considering the extent to which the minimum coverage provision can be severed from the remainder of ACA, if it is found to be unconstitutional. Finally, the Court is analyzing ACA\u2019s expansion of the Medicaid program and whether it unconstitutionally \u201ccoerces\u201d states into compliance with federal requirements. This last issue will be addressed in CRS Report R42367, Federalism Challenge to Medicaid Expansion Under the Affordable Care Act: Florida v. Department of Health and Human Services, by Kenneth R. Thomas.\nWhile there is no specific enumerated constitutional power to regulate health care or establish a minimum coverage provision, Congress\u2019s taxing power or its power to regulate interstate commerce may be pertinent. With regard to the taxing power, the requirement to purchase health insurance might be construed as a tax and upheld so long as it was found to comply with the constitutional restrictions imposed on direct and indirect taxes. On the other hand, opponents of the minimum coverage provision may argue that since it is imposed conditionally and may be avoided by compliance with regulations set out in the statute, that the requirement may be more accurately described as a penalty. If so, the taxing power alone might not provide Congress the constitutional authority to support this provision. \nIn evaluating the minimum coverage provision under the Commerce Clause, one of several issues that may be examined is whether the individual mandate is a regulation of economic activity. Some argue that the requirement to purchase health insurance is economic in nature because it regulates how an individual participates in the health care market, through insurance or otherwise. Conversely, others argue that forcing individuals to participate in commerce in order to regulate them goes beyond the bounds of the clause. \nThis report analyzes certain constitutional issues raised by requiring individuals to purchase health insurance under Congress\u2019s authority under its taxing power or its power to regulate interstate commerce. It also addresses whether the exceptions to the minimum coverage provision to purchase health insurance satisfy First Amendment freedom of religion protections. Finally, this report discusses some of the more publicized legal challenges to ACA, as well additional issues that are currently before the Court.", "type": "CRS Report", "typeId": "REPORTS", "active": false, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40725", "sha1": "b967653c616a022f284d0c008756309ad8246b5f", "filename": "files/20120406_R40725_b967653c616a022f284d0c008756309ad8246b5f.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40725", "sha1": "6e044e625c49fb0b44c1a840c7fd812f29407fc3", "filename": "files/20120406_R40725_6e044e625c49fb0b44c1a840c7fd812f29407fc3.pdf", "images": null } ], "topics": [] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc806315/", "id": "R40725_2011Feb01", "date": "2011-02-01", "retrieved": "2016-03-19T13:57:26", "title": "Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis", "summary": "This report first analyzes the authority of Congress to enact the minimum essential coverage\r\nrequirement contained in Patient Protection and Affordable Care Act (PPACA), as well as how a court might analyze this provision if challenged based on various provisions of the Fifth and Tenth Amendments. This report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion, and finally, discusses some of the legal challenges to this federal requirement.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20110201_R40725_49784fd075c5fb5ab8833c6bf7fc76838e2ed34b.pdf" }, { "format": "HTML", "filename": "files/20110201_R40725_49784fd075c5fb5ab8833c6bf7fc76838e2ed34b.html" } ], "topics": [ { "source": "LIV", "id": "Health insurance", "name": "Health insurance" }, { "source": "LIV", "id": "Health policy", "name": "Health policy" }, { "source": "LIV", "id": "Public health laws", "name": "Public health laws" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc815463/", "id": "R40725_2010Dec16", "date": "2010-12-16", "retrieved": "2016-03-19T13:57:26", "title": "Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis", "summary": "This report first analyzes the authority of Congress to enact the minimum essential coverage\r\nrequirement contained in the Patient Protection and Affordable Care Act (PPACA), as well as how a court might analyze this provision if challenged based on various provisions of the Fifth and Tenth Amendments. This report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion, and finally, discusses some of the legal challenges to this federal requirement.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20101216_R40725_a314a0475d2b07a8f160cb6483a4de0931600791.pdf" }, { "format": "HTML", "filename": "files/20101216_R40725_a314a0475d2b07a8f160cb6483a4de0931600791.html" } ], "topics": [ { "source": "LIV", "id": "Health insurance", "name": "Health insurance" }, { "source": "LIV", "id": "Health policy", "name": "Health policy" }, { "source": "LIV", "id": "Public health laws", "name": "Public health laws" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc820533/", "id": "R40725_2010May07", "date": "2010-05-07", "retrieved": "2016-03-19T13:57:26", "title": "Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis", "summary": "This report first analyzes the authority of Congress to pass a law of this nature, as well as how a court could analyze this provision in light of a constitutional challenge based on various provisions of the Fifth and Tenth Amendments. Finally, this report discusses whether the exceptions to the individual responsibility requirement to purchase health insurance satisfy First Amendment freedom of religion protections.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20100507_R40725_6e76e692d25fbe8c6b820d138e6f6fdb8a2c83e3.pdf" }, { "format": "HTML", "filename": "files/20100507_R40725_6e76e692d25fbe8c6b820d138e6f6fdb8a2c83e3.html" } ], "topics": [ { "source": "LIV", "id": "Health insurance", "name": "Health insurance" }, { "source": "LIV", "id": "Health policy", "name": "Health policy" }, { "source": "LIV", "id": "Public health laws", "name": "Public health laws" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc822651/", "id": "R40725_2009Jul24", "date": "2009-07-24", "retrieved": "2016-03-19T13:57:26", "title": "Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis", "summary": "This report first analyzes the authority of Congress to pass a proposal of this nature, as well as how a court could analyze this type of proposal if there were to be a constitutional challenge based on various provisions of the Fifth Amendment. Finally, this report discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20090724_R40725_0f36d9268976acb4e4db9a2f1b90208ec81e92d2.pdf" }, { "format": "HTML", "filename": "files/20090724_R40725_0f36d9268976acb4e4db9a2f1b90208ec81e92d2.html" } ], "topics": [ { "source": "LIV", "id": "Health insurance", "name": "Health insurance" }, { "source": "LIV", "id": "Health policy", "name": "Health policy" }, { "source": "LIV", "id": "Public health laws", "name": "Public health laws" } ] } ], "topics": [ "Constitutional Questions" ] }