The legal battle over the constitutionality of the Health Care Reform Act (Act) is on its way to the U.S. Supreme Court for a final decision. To date, multiple federal trial courts have been sharply divided on the constitutionality of the “individual mandate” requirement. The individual mandate is but one provision in a massive piece of legislation — but most consider it to be the linchpin to provide affordable health insurance coverage for all. This is because the Act requires all individuals to obtain health insurance or pay a penalty. The Act presumes that the vast majority of people will elect to purchase insurance rather than to pay a penalty. In exchange for providing a broad pool of insureds paying premiums to insurers, the Act prohibits insurers from denying coverage to applicants with pre-existing conditions, setting lifetime limits on coverage and setting annual benefit limits. If the individual mandate is invalidated, this balance collapses.

The constitutional question turns on whether Congress, under its power to regulate interstate commerce, can require individuals to purchase health insurance. The Commerce Clause provides that Congress has the power to “regulate Commerce … among the several states” including activities “substantially affecting” interstate commerce. Judges do not agree on whether a requirement to purchase health insurance falls within this power. Five federal district court judges have ruled on the constitutionality of the individual mandate. Of those five, three upheld it and two struck it down. A judge in northern Florida reasoned that the individual mandate was so essential to the Act that he struck down both the individual mandate and the entire Act. These five decisions have been appealed to various U.S. courts of appeal. To date, the Sixth Circuit Court of Appeals upheld the individual mandate as constitutional; the Fourth Circuit dismissed the appeal for lack of jurisdiction; and the Eleventh Circuit, ruling in the northern Florida case, agreed that the mandate should be struck down, but ruled that the judge should not have struck down the entire Act.