The States, Health Care Reform, and the Constitution


The recent enactment of health care reform legislation has generated substantial debate. Some of the loudest voices have been state politicians critical of the Patient Protection and Affordable Health Care Act, who claim that the Act violates our Constitution and principles of federalism. However, the words of the Constitution and the text of the Act itself tell a different story: the Act actually preserves the vibrant federal-state partnership that is the hallmark of our federalist system and falls well within Congress’s constitutional powers.

To help set the record straight, CAC has prepared an issue brief entitled “The States, Health Care Reform, and the Constitution.” This issue brief demonstrates that Congress clearly had the authority to pass health care reform–including the individual mandate–and that the legal challenges to the Act, filed by a handful of State Attorneys General, are more political theater than genuine constitutional argument. The issue brief also explains why state efforts to block implementation of the Act outright–known as state “nullification” of federal law–are an attack on the Constitution and purely symbolic at best.  Finally, the issue brief highlights aspects of the Act that preserve the role of the States as “laboratories of democracy,” allowing the States considerable flexibility to shape insurance exchanges or even opt out of the Act–including opting out of the individual mandate–so long as they create an alternative system that meets certain coverage and cost containment requirements.

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