Constitutional challenges to the Patient Protection and Affordable Care Act

Since the passage of the Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA), there have been numerous actions in federal courts to challenge the constitutionality of the legislation. This article describes the challenges by states against the ACA, reactions from legal experts with respect to its constitutionality, several federal court rulings on the ACA's constitutionality, the final ruling on the constitutionality of the legislation by the United States Supreme Court in National Federation of Independent Business v. Sebelius, and notable subsequent lawsuits challenging the ACA.

Some organizations and lawmakers who opposed the passage of the ACA took legal action following its passage. Several court challenges involved attempts to invalidate key provisions of the ACA. As of July 2013, none of these challenges had succeeded.

Twenty-eight states filed joint or individual lawsuits (including 26 states engaged in a joint action) to strike down the ACA's individual mandate. In a press release, the Attorneys General for several states indicated their primary basis for the challenge was a violation of state sovereignty. Their release repeated the claim challenging the federal requirement under threat of penalty, that all citizens and legal residents have qualifying health care coverage. It also claimed that the law puts an unfair financial burden on state governments. The lawsuit states the following legal rationale:

Regulation of non-economic activity under the Commerce Clause is possible only through the Necessary and Proper Clause. The Necessary and Proper Clause confers supplemental authority only when the means adopted to accomplish an enumerated power are 'appropriate', are 'plainly adapted to that end', and are 'consistent with the letter and spirit of the constitution.' Requiring citizen-to-citizen subsidy or redistribution is contrary to the foundational assumptions of the constitutional compact.

Other states were either expected to join the multi-state lawsuit or are considering filing additional independent suits. Members of several state legislatures are attempting to counteract and prevent elements of the bill within their states. Legislators in 29 states have introduced measures to amend their constitutions to nullify portions of the health care reform law. Thirteen state statutes have been introduced to prohibit portions of the law; two states have already enacted statutory bans. Six legislatures had attempts to enact bans, but the measures were unsuccessful. In August 2010, a ballot initiative passed overwhelmingly in Missouri that would exempt the state from some provisions of the bill. Many Missouri legal analysts expect that the measure will be struck down if challenged in Federal court.

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