Department of Health and Human Services v. Florida

The State of Florida and several other states, individuals, and the National Federation of Independent Business (plaintiffs) brought an action against the United States Department of Health and Human Services (defendant) to challenge the constitutionality of the Patient Protection and Affordable Care Act (ACA). The challengers argued, among other things, that the ACA’s individual mandate (i.e., the provision of the ACA that required individuals to purchase a health-insurance policy or pay a penalty) exceeded Congress’s powers. In enacting the ACA, Congress claimed that the individual mandate would lower insurance premiums because healthy people would be forced to enter the health-insurance risk pool. After federal appellate courts split on the individual mandate’s constitutionality, the United States Supreme Court granted certiorari. In briefing before the Court, the challengers asserted that Congress’s authority to regulate interstate commerce under the Commerce Clause does not give Congress the power to require individuals to participate in commerce. According to the challengers, Congress may regulate interstate commerce only if (1) the regulated conduct substantially interferes with interstate commerce or the regulation of interstate commerce, (2) the conduct is economic in nature, and (3) Congress can regulate the conduct without authorizing an unlimited exercise of federal power. Congress may not justify a regulation merely by showing that the regulation will positively affect commerce. Accordingly, the challengers asserted that the relevant question in assessing the individual mandate’s constitutionality was not whether the individual mandate would benefit commerce by lowering insurance premiums. Rather, the challengers asserted that the relevant question was whether the regulated conduct—i.e., not having health insurance—negatively affects commerce. The challengers argued that an individual’s uninsured status does not interfere with commerce or constitute economic activity because uninsured people are not participating in commerce. The challengers asserted that Congress could not force those uninsured people to participate in commerce by purchasing health insurance just to lower premiums for other people who had voluntarily chosen to participate in the insurance market.