Judicial Activism and the Affordable Care Act

President Obama and the White House responds to yesterday's ruling by a Federal Judge down in Florida that declared the Affordable Care Act unconstitutional.

Posted at The White House Blog by Stephanie Cutter on January 31, 2011

Today, a judge in Florida issued a decision in a case filed by 25 Republican Attorneys General and Governors striking down the Affordable Care Act. This ruling is well out of the mainstream of judicial opinion. Twelve federal judges have already dismissed challenges to the constitutionality of the health reform law, and two judges – in the Eastern District of Michigan and Western District of Virginia – have upheld the law. In one other case, a federal judge in the Eastern District of Virginia issued a very narrow ruling on the constitutionality of the health reform law’s “individual responsibility” provision and upheld the rest of the law.

Today’s ruling – issued by Judge Vinson in the Northern District of Florida – is a plain case of judicial overreaching. The judge’s decision contradicts decades of Supreme Court precedent that support the considered judgment of the democratically elected branches of government that the Act’s “individual responsibility” provision is necessary to prevent billions of dollars of cost-shifting every year by individuals without insurance who cannot pay for the health care they obtain. And the judge declared that the entire law is null and void even though the only provision he found unconstitutional was the “individual responsibility” provision. This decision is at odds with decades of established Supreme Court law, which has consistently found that courts have a constitutional obligation to preserve as a much of a statute as can be preserved. As a result, the judge’s decision puts all of the new benefits, cost savings and patient protections that were included in the law at risk.

Under today’s view of the law, seniors will pay higher prices for their prescription drugs and small businesses will pay higher taxes because small business tax credits would be eliminated. And the new provisions that prevent insurance companies from denying, capping or limiting your care would be wiped away.

We don’t believe this kind of judicial activism will be upheld and we are confident that the Affordable Care Act will ultimately be declared constitutional by the courts.

History and the facts are on our side. Similar legal challenges to major new laws -- including the Social Security Act, the Civil Rights Act, and the Voting Rights Act -- were all filed and all failed. And contrary to what opponents argue the new law falls well within Congress’s power to regulate economic activity under the Commerce Clause, the Necessary and Proper Clause, and the General Welfare Clause.

Those who claim that the “individual responsibility” provision exceeds Congress’ power to regulate interstate commerce because it penalizes “inactivity” are simply wrong. Individuals who choose to go without health insurance are actively making an economic decision that impacts all of us. People who make an economic decision to forego health insurance do not opt out of the health care market. As Congress found, every year millions of people without insurance obtain health care they cannot pay for, shifting tens of billions of dollars in added cost onto those who have insurance and onto taxpayers. There can be no doubt that this activity substantially affects interstate commerce, and Congress has the power to regulate it.

The Affordable Care Act, through the individual responsibility requirement, will require everyone, if they can afford it, to carry some form of health insurance since everyone at some point in time participates in the health care system, and incur costs that must be paid for. For the 83% of Americans who have coverage and who are already taking responsibility for their health care, their insurance premiums will decrease over time. Many of those who are currently struggling to pay for insurance will get a new tax credit. Only those who are able to pay for health insurance will be responsible for obtaining it. Because most people would voluntarily purchase coverage as it becomes more affordable and the policy exempts those for whom purchase would cause a financial hardship, the Congressional Budget Office estimated that only 1 percent of all Americans would pay a penalty for not having health insurance in 2016....

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HOLT SUPPORTS HOUSE HEALTH CARE REFORM PROPOSAL IN COMMITTEE; PLEDGES TO IMPROVE BILL AS PROCESS CONTINUES

FOR IMMEDIATE RELEASE
July 17, 2009

As Member of House Committee on Education and Labor, Holt Works to Strengthen Public Option, Small Business and Health Care Employment Training

(Washington, DC) – Rep. Rush Holt (NJ-12) today voted for – in the House Committee on Education and Labor – the America’s Affordable Health Choice Act, legislation introduced in the House, with the intention of extending coverage to all Americans, improving the quality of care, expanding preventative care, and reducing the health care costs that Americans pay. The reform proposal would build on the existing system, so that if people are happy with the insurance they have, they can keep it. While helping to pass the bill in Committee, Holt noted that this is an intermediate step in the legislative process and that he wants to continue to improve the bill, strengthening the parts providing for a public option, small business benefits, and training for health care workers.

In June, Holt hosted a group of Central New Jersey primary care and patient advocates in Washington to hear their experiences on the front-line of health care and meet with leaders in health reform. For example, a pediatrician shared her story that primary care providers like her are struggling to see more patients, while receiving lower payments from insurance companies for her primary care services. On Monday, Holt held a roundtable at the Henry J. Austin Health Center in Trenton. Participants included small business owners, patient advocates, health care providers, doctors and nurses.

“We no longer can accept the status quo. I believe this year we will reform our broken health care system, but I know this will not be easy,” Holt said. “Since Teddy Roosevelt was President, the Congress has tried to pass universal health reform. However, with Presidential leadership, a supportive Congress, and an American public that understands what is at stake, the table is set for historic reform. As primary care providers and patients from Central New Jersey have told me, we must fix our health care system to keep individuals healthy, prevent diseases, and provide health security for all Americans. Today we have taken an important, though not final, step.”

A summary of the legislation can be found at http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BILLSUMMARY-071409.pdf.

In supporting the bill in Committee, Holt highlighted two features: creating a public health insurance plan and increasing the resources devoted to primary care. Holt argued that a public health insurance plan needs to be included to lower costs and improve health care delivery. In addition to increasing competition, Holt said, a public plan would provide a way to inject innovative strategies to deliver higher-quality and lower-cost health care, such as encouraging integrated medical care and increasing primary care. Holt also noted that the legislation includes several proposals to improve primary care by increasing the workforce and enlarging community health centers.

“In 2009, health care spending is projected to reach $8,160 per person, an amount sufficient to provide excellent care for everyone, yet 46 million Americans lack insurance and millions more have coverage that doesn’t meet their needs. Without health reform, businesses’ costs will continue to increase, families’ out-of-pocket costs will rise, and American workers will not receive the health care they need,” Holt said.

In addition to these provisions, Holt succeeded in adding two amendments to the legislation. One amendment would provide additional job training in order to expand the health care workforce. The White House Council on Economic Advisors released a report this week noting that the number of health care practitioner jobs, such as physicians and nurse practitioners, will grow by 35 percent between 2000 and 2016. Demand for health care support occupations, including medical records and health information technicians, clinical laboratory technicians, and physical therapists are expected to increase by 48 percent.

The bill would creates a competitive National Health Workforce Online Training Grant program for universities, community colleges, non-profits, workforce investment boards, and others to increase the number of online training programs for individuals seeking health care jobs. Grant recipients would be required to reach out to workforce investment boards, local governments, educational institutions, and other workforce training organizations to disseminate their knowledge. The bill also would establish an online health professions training program clearinghouse, which would collect and nationally disseminate the best practices learned by grantees.

The online job program would support programs similar to one offered by Rutgers University and the New Jersey Department of Labor and Workforce Development. The Director of the Rutgers Center for Women and Work, Dr. Eileen Applebalum, and Assistant Professor and Senior Research Scientist, Dr. Mary Gatta commended Holt for including the amendment.

“As so much research, including our own, has demonstrated online learning provides significant benefits and advantages to dislocated and incumbent workers in developing and expanding their skills to compete in our economy,” Appelbaum and Gatta wrote in a letter. “Online learning provides accessible, flexible, cost-effective, and most-up-to date training. This is particularly important in the healthcare fields, as there are significant shortages of skilled workers in several fields, and existing workers must ensure that their skills are compatible with job demands.”

Another amendment, which Holt cosponsored with Subcommittee Chair Rob Andrews and Reps. Phil Hare and Donald Payne would create small employer benefit arrangements (SEBAs), which provide a new way for affiliated small businesses to join together to offer health insurance and other benefits to their employees.

Holt first learned about SEBAs from Wilson H. Beebe, Jr., Chairman, the Alliance for Employee Benefit Cooperatives and Executive Director, New Jersey State Funeral Directors Association. Beebe regonized the work of Holt and others for including the amendment in the legislation.

“We appreciate all of their hard work and are lucky to have such effective legislators representing us in Washington,” Beebe said. “Self-governed SEBAs will assist small businesses in taking advantage of the opportunities provided by national health reform. By allowing SEBAs to negotiate premium and plan design on the basis of occupational demographics and administrative economies of scale, we expect to further reduce premium costs. Moreover, we can provide professional evaluation of the plan options available in the market-place suitable to our membership and workforce.”