Earlier today, the United States Supreme Court heard argument about whether Congress exceeded its constitutional authority when it passed the minimum coverage provision of the Affordable Care Act. This provision which is often referred to by the misnomer, the individual mandate, requires nearly everyone to obtain health insurance or face paying a financial penalty as high as $3,000.00 with their tax return. Although the parties and amici have raised several constitutional provisions in support and opposition of the minimum coverage provision, the most frequently discussed and debated question is whether the disputed provision oversteps Congress’s authority to regulate interstate commerce.
Before discussing the legal arguments of each side, it is important to discuss the environment in which the Act was passed. All hospitals with an emergency department that accept Medicare payments, which is to say nearly all hospitals, are required to provide medical services to anyone who walks through their doors, regardless of their ability to pay. See Emergency Medical and Treatment and Active Labor Act of 1996, 42 U.S.C. § 1395dd. According the American Hospital Association, hospitals in the last decade have provided $300 billion in uncompensated care to the uninsured and underinsured. Moreover, in 2008, uninsured Americans received $86 billion worth of health care from all providers. See J. Hadley et al., Covering the Uninsured in 2008: Current Costs, Sources of Paryment & Incremental Costs 399, 402-403, Health Affairs, Aug. 25, 2008. Of that $86 billion, approximately $56 billion was in the form of uncompensated care. Id. at 399.
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