6th Circuit: In Health Care, All Individuals are Active

Congress had a rational basis for concluding that the minimum coverage provision is essential to the Affordable Care Act's larger reforms to the national markets in health care delivery and health insurance. Finally, the provision regulates active participation in the health care market, and in any case, the Constitution imposes no categorical bar on regulating inactivity."

Federal law already requires health care providers to provide emergency treatment regardless of patients' ability to pay, Martin says.

"The unavoidable need for health care coupled with the obligation to provide treatment make it virtually certain that all individuals will require and receive health care at some point," Martin says. "Thus, although there is no firm, constitutional bar that prohibits Congress from placing regulations on what could be described as inactivity, even if there were it would not impact this case due to the unique aspects of health care that make all individuals active in this market."

Graham, the judge who wrote the opinion concurring in part and dissenting in part, says in his opinion that he agrees with the majority that the plaintiffs had standing to bring the case and that, under the Anti-Injunction Act, the 6th Circuit had the jurisdiction to consider the appeal.

Graham says he disagrees with his colleagues' analysis of the relationship between the Commerce Clause and the PPACA coverage ownership mandate.

"The mandate is a novel exercise of Commerce Clause power," Graham writes. "To approve the exercise of power would arm Congress with the authority to force individuals to do whatever it sees fit (within boundaries like the First Amendment and Due Process Clause), as long as the regulation concerns an activity or decision that, when aggregated, can be said to have some loose, but-for type of economic connection, which nearly all human activity does."

Panels at the 4th Circuit and 11th Circuit have heard oral arguments on cases relating to the constitutionality of the PPACA coverage ownership requirements. Many U.S. district court judges have ruled that the requirements are constitutional, but U.S. District Judge Henry Hudson of Richmond, Va., has ruled that it is unconstitutional. U.S. District Judge Roger Vinson of Pensacola, Fla., has ruled that the provision is unconstitional and akin to a law requiring the people of the United States to eat broccoli.

Other PPACA Mandate case coverage from National Underwriter Life & Health:

• PPACA: Curtain Opens on Individual Mandate Appeal
• PPACA: Is it Constitutional?
• Legislating from the Bench
• PPACA: Federal Judge Rejects Individual Mandate
• PPACA: Sebelius Responds To Constitutionality Suit
• PPACA: Federal Judge Lets Cuccinelli vs. Sebelius Proceed