Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis. April 6, 2012.

摘要

Although the federal government provides health coverage for many individuals through federal programs such as Medicare, it has never required individuals to purchase health insurance until the enactment of the Patient Protection and Affordable Care Act1 (ACA) in March of 2010. While a requirement to transfer money to a private party may arise in other contexts (e.g., automobile insurance), it has been noted that these provisions are based on exercising a privilege, like driving a car. Thus, due at least in part to the novelty of this requirement, there have been questions debated over its constitutionality, and several lawsuits have challenged the minimum coverage provision on constitutional grounds. These challenges have reached the Supreme Court, where oral arguments in the cases took place during the last week of March, 2012. This report first analyzes the authority of Congress to enact the minimum coverage provision contained in ACA and discusses whether there must be exceptions to a requirement to purchase health insurance based on First Amendment freedom of religion. It finally examines some of the legal challenges to this federal requirement as well as other questions (relating to the Anti- Injunction Act and severability) that the Supreme Court is considering in conjunction with the minimum coverage provision. For a discussion of the constitutional challenge to ACA's expansion of the Medicaid program, see 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.