AAPD Defends Health Care Reform Act in Supreme Court Case

January 17, 2012  |  David Heymsfeld

AAPD and thirteen other organizations which advocate on health and disability issues have filed an amicus brief with the United States Supreme Court, defending the health care reform act (the Affordable Care Act) against claims that Congress did not have constitutional authority to pass the Act.

The amicus brief emphasizes the importance of the ACA’s reforms for persons with disabilities. A very important reform is the requirement that health insurance policies must be available, without extra charge, to persons with conditions that may require care under the policy. (known as “preexisting conditions”). Without this reform, many persons with disabilities will continue to be unable to purchase insurance on reasonable terms.

The brief demonstrates that a requirement that insurance be made available without regard to preexisting conditions will not be feasible unless there is also a requirement that all persons purchase insurance (known as the “individual mandate”). Without the mandate, large numbers of persons with preexisting conditions will purchase insurance, but a significant number of young “healthy” persons will not. As a result, the revenues from premiums will not be sufficient to cover the added expenses arising from coverage of persons with preexisting conditions.

The need for an individual mandate has been demonstrated by the experience of States that have passed health reform. The brief describes the experience in seven States that passed reform laws prohibiting consideration of preexisting conditions without also requiring all persons to purchase insurance. The result was that insurance companies either dropped out of the market or raised premiums to unacceptable levels.

By contrast, Massachusetts that had both the prohibition on consideration of preexisting conditions and the individual mandate was successful in providing coverage at reasonable rates for persons with preexisting conditions.

In the Supreme Court case, it is argued by opponents of the ACA that Congress’ constitutional power to regulate interstate commerce does not include the power to require persons to participate in commerce by purchasing health insurance. The amicus brief uses the experience in the States to rebut this argument. The brief points out that Congress unquestionably has the power to regulate insurance in interstate commerce by prohibiting refusals to sell insurance to persons with preexisting conditions.  However, as demonstrated by experience in the States, ensuring coverage for persons with preexisting conditions can work only if there is a complimentary requirement that persons who can afford it carry insurance. Accordingly the individual mandate is constitutional because it is an essential element of Congress’ constitutional power to regulate interstate commerce to require that health insurance must be sold to persons with preexisting conditions.

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