Health-care lawsuit: The real need is for a wiser approach to reform

Congressional supporters of the health reform act had plenty of warning that, however good its intentions, the bill was venturing into unprecedented legal ground.

U.S. Capitol Building

U.S. Capitol Building

The accusations are as insidious as they are inaccurate. An e-mail was circulated earlier this month by a member of Congress accusing me of trying to “wipe out” the entire health care reform law, eliminate health care coverage for children with congenital heart defects, and take prescription drugs away from seniors. Hours later, Gov. Chris Gregoire, flanked by U.S. Health and Human Services Secretary Kathleen Sebelius, accused me of trying to have the entire law thrown out. She raised the specter that many seniors would each lose $250 worth of coverage and small business people would lose tax credits, among other ominous claims.

Perhaps advocates for government-controlled health care engage in these over-the-top tactics because they’re not interested in discussing the legality of their agenda. After all, two federal judges recently agreed with 28 state officials — governors and attorneys general — who believe that parts of the new national health care law violate the Constitution. 

Apparently those who think the government should control your health care choices think the U.S. Constitution is an inconvenience that can be brushed aside.

Their demagoguery allows them to change the subject away from the uncomfortable truth that Congress was warned by both the Congressional Research Service and Congressional Budget Office that the health insurance mandate is unprecedented and constitutionally problematic. Congress ignored these warnings. They compounded that error by removing a severability clause from an earlier draft of the bill that would have expressed the intent of Congress to preserve the rest of the law should any one provision be struck down. Federal Judge Roger Vinson cited the clause's removal as evidence that the bill's drafters did not want the individual health insurance mandate to be severable from the rest of the healthcare law. 

Perhaps if the 220 House members who voted to approve the bill had actually read it beforehand, they would have appreciated the significance of this blunder. They effectively put the entire healthcare reform measure at risk by including an untested mandate that their own staff members had repeatedly questioned and cautioned against, then arrogantly removed language that would have protected the bill should the mandate be struck down.

Everyone in Congress knew that a law this sweeping — one that impacts every single American’s health care options — would be challenged in court. We’re a nation that reveres our Constitution.

Those of us who signed on to the lawsuit all agree that the mandate requiring all U.S. citizens to have or purchase health insurance, or face a fine levied by the Internal Revenue Service, violates the powers granted to Congress.  The Constitution limits the power of the federal government in order to assure that federalism is real and lasting, and that the rights reserved to the states and individuals are respected and protected.

If Congress may require you to buy a government-mandated private product, are there any remaining limits on the power of the federal government to control our individual choices? Once those limits are erased, what else may a future Congress compel us to do?

These are questions that deserve serious consideration, as all the courts considering challenges to the individual health insurance mandate have agreed. Not one of them has dismissed those challenges as "frivolous" — exactly the charge that several state and federal elected officials and law school academics hastily and erroneously hurled at the states' lawsuit.  Notwithstanding their embarrassment in being proved wrong in predicting the lawsuits' dismissal, proponents of the health care law are undaunted in their desire to demagogue and attack dissenting voices.

I have publicly stated from the beginning that there are specific parts of the 2,700-page law that I believe are unconstitutional, and that these parts should be struck down and severed from the remainder. Federal Judge Henry Hudson reached the same conclusion in Virginia's challenge to the individual health insurance mandate. Judge Vinson, in the 26-state case in Florida, disagreed and invalidated the entire law. While I believe that the U.S. Supreme Court will ultimately agree with Judge Hudson, the Vinson ruling against severability highlights the needless risk taken by Congress in incorporating the mandate while deleting the severability clause.

Regardless of the Supreme Court's ultimate ruling, nothing prevents Congress from immediately fixing the legislation to make it constitutional. Despite their heated rhetoric, the governor and her allies in Washington D.C. know this to be true.

In fact, there’s a growing, bipartisan consensus in D.C. that removing the mandate is exactly what needs to be done. Even President Obama now acknowledges that an option other than the individual mandate can be found.

Reforming health care is incredibly important. Health care costs take an increasingly huge bite out of family —and state — budgets. And care should be affordable and available to all Americans. There are many solutions to these challenges that don’t conflict with the Constitution. However, some columnists, including Seattle Times editorial writer Lance Dickie, maintain that Republicans “fail to offer a single idea of their own.” In fact, Republicans have offered numerous concepts for bringing costs down while maintaining quality care. Those ideas include letting Americans deduct health insurance costs, allowing doctors to be paid for results rather than treatments, reducing abusive lawsuits against health providers, creating health savings accounts, and increasing competition by allowing health insurance to be sold across state lines.

Nearly every poll shows the healthcare law has never been popular with a majority of Americans. That’s likely because it was rammed through in a partisan process, rather than one built on consensus.  And still today, the bill’s advocates continue to use earth-scorching, divisive tactics to defend the law’s unconstitutional flaw. Instead, let’s reform health care while still respecting our nation’s foundational document.

I recognize that many of the bill’s advocates believe, as I do, in improving the health care system. However, as Daniel Webster once said, “Good intentions will always be pleaded for every assumption of authority. It is hardly too strong to say that the Constitution was made to guard the people against the dangers of good intentions.”


About the Author

Rob McKenna is the attorney general of Washington and a 2012 candidate for Governor.

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Comments:

Posted Tue, Mar 8, 12:34 p.m. Inappropriate

What a thoughtful piece. It's nice to see a public servant communicate without hyperbole or misinformation.

Thank you, Attorney General McKenna, for stating the facts clearly and cogently, and for upholding the constitution.

PJS

Posted Tue, Mar 8, 2:37 p.m. Inappropriate

I suggest people read Simon Lazarus' comprehensive analysis of the McKenna litigation to understand the potentially dire impact on civil rights laws and other cherished federal regulations if the Supreme Court upholds his challenge to the health care mandate.
http://www.acslaw.org/files/Lazarus%20-%20health%20reform%20lawsuits.pdf
As former Massachusetts Republican Governor Mitt Romney noted when signing that state's health care reform law containing an individual mandate to buy health insurance: "[S]omeone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on the government is not libertarian."
Mr. McKenna refers to the government controlling people's health care choices. But in fact the new health insurance exchanges starting in 2014 will give Americans an unprecedented array of private health insurance choices, similar to those available to members of Congress and federal employees. For Mr. McKenna to call this "government-controlled" health care is, to put it charitably, inaccurate.

Posted Tue, Mar 8, 3:25 p.m. Inappropriate

What a whiner! "insidious" this and "demagoguery" that. This is not looking very gubernatorial, Rob...

Look, everyone knows that this health care bill will not work without a mandate. If you take away the mandate, the whole thing falls apart. People would just wait until they get sick, then go buy insurance. Make no mistake--Rob is out to dismantle the whole thing.

There is another federal mandate that requires hospital emergency rooms to not turn away emergency cases. This is the current way for many uninsured to get medical care, paid for by tax payers and higher insurance rates. Why don't you go after that federal mandate, Rob? This would achieve the Libertarian/Scroogian dream of having the poor die in the streets to decrease the surplus population.

andy

Posted Tue, Mar 8, 6:57 p.m. Inappropriate

While the column is interesting from a legal standpoint..it does not solve the 'moral' problem that we are facing with a for profit health care system. How do we ensure that everyone has access to a doctor and medical care without resorting to an emergency room? We have a for-profit health care system (even our non-profits act like for profits). Without everyone buying insurance, it is not profitable to insure the sick, the middle-aged and elderly. So for profit companies will continue to try to insure only those who are healthy. Those people with pre-existing conditions, and those with expensive diseases (think Cancer patients that have been dropped) won't get insured or will continue to lose their insurance. The Constitution is important, but so is the right to see a doctor. Insurance exchanges, tort reform, etc., is only a minor fix. Profit motive is profit motive. And we should have all learned from the Wall Street debacle that at times free market capitalism only serves a small percentage of people. Again, while Mr. McKenna's views are interesting he doesn't solve the biggest health insurance problem of all.. access to health care..and most importantly, access to affordable health care.

Leah

Posted Tue, Mar 8, 7:30 p.m. Inappropriate

Leah, I like your points but most constitutional scholars (and so far three federal district judges, which AG McKenna skipped over) see no contradiction between our Constitution and the health reform law's requirement that everyone obtain health insurance. This falls under the Constitutional provision that Congress has the power to regulate interstate commerce; the health insurance industry is surely interstate commerce. McKenna's argument that this could give the government the power to order Americans to do almost anything (Judge Vinson actually said it could lead to requiring people to eat broccoli or join a health club) is ludicrous, both legally and politically. Check out the Lazarus analysis I linked to and see what you think.

Posted Wed, Mar 9, 9:57 a.m. Inappropriate

The health care mandate was an unprecedented expansion of Commerce Clause authority -- prior to 1932. For better or worse, since the New Deal this kind of expansive usage has been rather common. It looks to me like the Choir Boy is looking for a safe pew to hide under.

woofer

Posted Wed, Mar 9, 11:44 a.m. Inappropriate

It would be one thing if the mandate applied equally to everyone, but deals have been cut to exempt the usual suspects (unions, tribes, etc). If Congress cannot treat people equally under the law, the law is no good.

BlueLight

Posted Wed, Mar 9, 12:05 p.m. Inappropriate

Rob, you aren't going to be governor of Washington with an attitude like this.

You can whine all you want about the lack of constitutional mandate for buying health care, but it comes across as self serving of your Republican base when you also ignore the laws for Fraud in the Mortgage Backed Security Cases. (ie foreclosing without actually holding title to the property, failing to register title transfers with the county instead relying on MERS, an illegal entity. The lack of any titles in a Mortgage backed Security bond, the under oath testimony of Citi-Bank that they knew those securities were worthless. Washington State owned some of those I bet, we the WA tax payers have been defrauded.)

How about the lack of constitutional protection for the detainees in GITMO? The torture of Private Bradley? The torture of the detainees in GITMO? Why not prosecute the last administration for war crimes?

Those things are much more serious infringements on our rights.

You can't have it both ways, either you are going to enforce all the laws fairly and look like an Attorney General, or you can pander to your party and enforce only the ones that don't convict any of your party donors.

GaryP

Posted Wed, Mar 9, 12:50 p.m. Inappropriate

Gary P - read your state constitution. In the state of Washington, the Attorney General has no authority to investigate or prosecute crimes. He can only do so when asked to do so by a county prosecutor, typically when the county prosecutor has a conflict of interest. The points you make in your post are wholly inapposite.

You may not agree with Atty Gen McKenna's interpretation of the U.S. constitution, but he certainly has the authority to protect the state's interest in a civil suit. The federal courts will determine whether your reading of the U.S. constitution or Atty Gen McKenna's is correct.

PJS

Posted Wed, Mar 9, 1:41 p.m. Inappropriate

PJS,

Well then since WA Attorney Generals can't investigate crimes, what is the 50th state in this group?

http://seattletimes.nwsource.com/html/realestate/2013164472_realinquiry17.html

Seems Mr. McKenna can pick and choose which crimes to investigate.

As for Mr. McKenna protecting the interests of WA residents, I think that the crimes committed by the banks and the fraud in the selling of MBS bonds is well within his rights. But then he'd be prosecuting Republican party donors.

GaryP

Posted Wed, Mar 9, 1:47 p.m. Inappropriate

http://www.atg.wa.gov/FinancialCrimes.aspx

I'd say that failing to investigate the lack of title transfers and payment of fees is a crime against WA state.

http://www.atg.wa.gov/SafeguardingConsumers.aspx
I'd say that failing to have any actual mortgage titles in a MBS is fraud. And therefore a violation of the consumer protection acts of WA.

Rob's show himself to be a tool of the party and it will be his last term in office in WA state.

GaryP

Posted Wed, Mar 9, 3:07 p.m. Inappropriate

GaryP - you point to civil investigations and, with respect to financial crimes, investigation power only, NOT to prosecution power.

Are you suggesting that all Washington state prosecutors, Democrat and Republican, are colluding to not charge these fraudsters? What about Democrat attorney generals in other states?

PJS

Posted Wed, Mar 9, 3:08 p.m. Inappropriate

Would someone tell how marijuana can be illegal at the federal level? Is it the commerce clause?

andy

Posted Wed, Mar 9, 5:09 p.m. Inappropriate

BlueLight, unionized workers certainly are subject to the health reform law's mandate. I don't know where you got that. There are only a few limited exceptions, including native Americans (who I presume are covered by the Indian Health Service), people with certain narrow religious exemptions, and people who fall under the income threshhold but aren't poor enough to qualify for Medicaid. Unionized workers and other people who have health coverage through their employers satisfy the mandate in that way and can stick with their current coverage.

Posted Thu, Mar 10, 5:53 a.m. Inappropriate

There are now over 1,000 organizations covering 2.6 Million people who are waivered from confoming with the HCR. Yes, many of them are UNION members.

http://thehill.com/blogs/healthwatch/health-reform-implementation/147715-number-of-healthcare-reform-law-waivers-climbs-above-1000

Cameron

Posted Thu, Mar 10, 6:16 a.m. Inappropriate

Here is the list as of 1/26/2011 directly from HHS. You will note a number of unions. As cited in the article above an additional 300 waivers have been granted since the offical list upgrade on this link.

http://www.hhs.gov/ociio/regulations/approved_applications_for_waiver.html

Cameron

Posted Thu, Mar 10, 11:54 a.m. Inappropriate

Geez, Cameron, those waivers have nothing to do with enforcement of the individual mandate to buy coverage. Those are waivers demanded by companies to allow them to continue offering benefit plans with minimal benefits (known as mini-meds), and those waivers will only apply until 2014, when the mandate and federal subsidies to help people buy coverage kick in. That's what the HHS link you helpfully provided says if you read it. All the people covered under these plans receiving waivers will be subject to the individual mandate in 2014. This is why it's so difficult to have a rational discussion about the health reform law. There is so much misinformation and disinformation and misunderstanding about it.

Posted Thu, Mar 10, 11:58 a.m. Inappropriate

BTW, I hope folks read the Seattle Stranger's good piece about Rob McKenna, particularly the part about how he hasn't been straight with the public that his lawsuit seeks to invalidate the entire health care law, including the popular parts like ending pre-existing condition exclusions, allowing young people to stay on their parents' insurance plan, filling in the prescription coverage donut hole for seniors, etc. He insists in his Crosscut article and other public presentations that he wants to keep those good parts and just strike down the mandate, but that's not what his lawsuit says.
http://www.thestranger.com/seattle/could-washington-be-the-next-wisconsin/Content?oid=6987101

Posted Thu, Mar 10, 2:13 p.m. Inappropriate

PJS,

"Are you suggesting that all Washington state prosecutors, Democrat and Republican, are colluding to not charge these fraudsters? What about Democrat attorney generals in other states?"

Sure looks that way to me. Although NY has charged some of them. Arizona has been passing laws that require full documentation before foreclosure. But WA has done nothing to address the fraud. And the head of the WA legal representation is off chasing health care ghosts.

GaryP

Posted Thu, Mar 10, 3:18 p.m. Inappropriate

They would never extend the Waivers would they Harris?

Cameron

Posted Fri, Mar 11, 9:19 a.m. Inappropriate

Thanks GaryP. I love conspiracy theories. It makes their promulgators look so rational. What other conspiracies trouble you?

Here's what the AG is doing re foreclosure problems. Real-world problem solving, not grandstanding like Spitzer and Cuomo did when trying to prosecute people for so-called crimes, only to see charges thrown out of court after innocent people were forced to do perp walks in front of tv cameras.

http://atg.wa.gov/foreclosure.aspx#PROBLEMS

PJS

Posted Sat, Mar 19, 11:04 p.m. Inappropriate

Re: the mandate issue, apparently AG McKenna hasn't heard of mandatory automobile insurance or paying for car insurance within the price of gasoline. If we allow people to opt out, chances are the healthiest folks will, while the remainder will pay higher rates. Next point: only a fool believes that "consensus" doesn't mean that the big business lobbyists that support all politicians and especially Republicans won't skew what comes out towards the well-off folks. All one has to do is look at the tax code and the growing number of millionaires and billionaires in this country, who the politicians jealously guard - after all, most of them are millionaires - and whom seem to have an insatiable appetite for more and more money and tangible possessions. To think that the public could comprehend the complexity of health care is ludicrous. Also, people in general don't like change. I worked in a hospital in a department solely concerned with data. Imagine the number of health care coverages: what's covered and not, all of the thousands of procedure codes (look up CPT-4 codes to get a start), various deductibles, co-pays, annual limits, maximum limits, etc. Rather than simplify this system, the politicians - who all have gold-plated coverage that bypasses the snafus that the rest of us, even those with coverage, have - fight to protect it. The Rs would rather folks without coverage put it off until it's an emergency, then use the emergency rooms. Ever wonder why the co-pay for the ER is way more than an office visit? Yet, incorporating "best practices" to save costs and simplifying the coverage and breadth of regional health care is beyond the propagandizing of the politicians. Medicare is going broke, let's get off the fence and start serious fixing of the nation's biggest fiscal problem: health care.

bricsa

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