Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis Page: 4 of 42
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Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis
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 Act' (ACA)
in March of 2010.2 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.3 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.
Under Section 1501 of ACA, beginning in tax year 2014, some taxpayers will be assessed a
monetary penalty for any months during which they or their dependents lack "minimum
essential" health coverage.4 "Minimum essential coverage" includes coverage under a
government-sponsored health care program (e.g., Medicaid, Part A of Medicare); an "eligible"
employer-sponsored plan; coverage under a plan offered in the individual market; a grandfathered
health plan; and other health coverage as recognized by the Secretary of Health and Human
The amount of the assessment for failing to meet the individual mandate, which can be prorated
for partial compliance during the year, is determined by taking the greater of a flat dollar amount
1 Patient Protection and Affordable Care Act, P.L. 111-148, 1501(b) (2010), as amended by the Health Care and
Education Reconciliation Act of 2010 P.L. 111-152 1002 (2010). The requirement to purchase health insurance will
be referred to interchangeably, as either the minimum coverage provision or the individual mandate.
2 See Congressional Budget Office Memorandum, The Budgetary Treatment of an Individual Mandate to Buy Health
Insurance (August 1994) ("A mandate requiring all individuals to purchase health insurance would be an
unprecedented form of federal action.").
3 See Mark A. Hall, The Constitutionality of Mandates to Purchase Health Insurance, Legal Solutions in Health Care
Reform, available at http://www.rwjf.org/files/research/38108.3693.constitutionality.mandates.pdf. See also Ex Parte
Poresky, 290 U.S. 30 (1933) (Court agreed that a district court's dismissal of a complaint alleging that Massachusetts'
compulsory automobile liability insurance law violated the 14th Amendment was proper "in view of the decisions of
this Court bearing upon the constitutional authority of the State, acting in the interest of public safety, to enact the
statute assailed."). It should be noted that while laws related to military service (e.g., the draft) could be considered an
example of a federal mandate pertaining to individuals, the authority for these laws likely relies on Congress's authority
to raise and support armies. See generally Rostker v. Goldberg, 453 U.S. 57, 65 (1981); Selective Draft Law Cases, 245
U.S. 366 (1918).
4 P.L. 111-148, 1501(b), as amended by P.L. 111-152, 1002.
Congressional Research Servicee
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Staman, Jennifer; Brougher, Cynthia; Liu, Edward C.; Lunder, Erika K. & Thomas, Kenneth R. Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis, report, April 6, 2012; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc821696/m1/4/: accessed October 21, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.