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The Democrats gained control of Congress in 2007, and the debates about the CHAMP Act’s comparative effectiveness provisions had occurred against the party’s mobilization to win the White House. With the prospect of a Democratic president came the chance of comprehensive health care reform. In late2007 and early 2008 the US economy began its slide into the Great Recession and was in free-fall when Barack Obama was elected president in November 2008. Within 3 weeks the new administration was presenting its plans for fiscal stimulus. Many pieces of ready-to-go legislation were amalgamated to form the February 2009 American Recovery and Reinvestment Act, among them $1.1 billion for comparative effectiveness research. A cliff-hanger battle for health reform culminated in the March 2010 Affordable Care Act, one provision of which was a federal mandate for comparative effectiveness research modelled on a proposal of Senators Max Baucus (D-MT) and Kent Conrad (D-ND).

This chapter examines when and how the constitutional challenge to the so-called individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA), which requires almost everyone to purchase health insurance, arose. It first charts the beginnings of arguments that the ACA mandate was unconstitutional, including those put forward by David Rivkin and Lee Casey, Peter Urbanowicz and Dennis G. Smith, Rob Natelson, Jonathan Adler and Ilya Somin, and Randy Barnett. In particular, it analyzes the philosophical assumptions underlying Barnett's Tough Luck Libertarianism as well as his interpretation of the Constitution regarding the ACA mandate. The chapter then turns to lawsuits that were filed against the ACA hours after it was signed by President Barack Obama on March 23, 2010, leading to the elevation of the case to the Supreme Court. It also considers the argument that Judge Ruth Bader Ginsburg termed the Broccoli Horrible before concluding with an assessment of various court decisions on the constitutionality of the mandate.

This book examines the constitutional challenge to the so-called individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA), which requires almost everyone to purchase health insurance. It charts the history of health care reform in America and of Supreme Court cases dealing with the regulation of interstate commerce, and how the logic of reform led Congress to choose the individual mandate over other, functionally equivalent but politically impossible ways of delivering near-universal health care. It also considers the appropriate constitutional limits on congressional power, when and how the constitutional objections to the mandate were devised, the Supreme Court's ruling on the issue, and the decision's aftermath. The book argues that the constitutional arguments against the mandate are dubious and explains why.

This chapter examines the consequences of the Supreme Court's decision on the constitutionality of the so-called individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA), which requires almost everyone to purchase health insurance. It first discusses how the decision changed the ACA before turning to the Court's ruling regarding the Medicaid expansion. It then considers the implications of Tough Luck Libertarianism for health care.

This chapter examines the history of health care reform in America leading to the so-called individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA), which requires almost everyone to purchase health insurance. After charting the origins of health insurance, it discusses the establishment of Medicare and Medicaid and the state of the American health care system under Barack Obama. It analyzes Congress's decision to choose the mandate over other, functionally equivalent but politically impossible ways of delivering near-universal health care.

This chapter examines the appropriate constitutional limits on congressional power over the so-called individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA), which requires almost everyone to purchase health insurance. It first considers Congress's powers as mandated by the Constitution, with particular emphasis on its commerce power which is the source of its ability to regulate the insurance industry. It then turns to the Necessary and Proper Clause of the Constitution, a major obstacle to the constitutional challenge to the ACA, and court attempts to craft limits on congressional power. It also discusses the principle of subsidiarity and concludes by explaining why the mandate is constitutional.

This chapter examines the Supreme Court's decision on the constitutionality of the so-called individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA), which requires almost everyone to purchase health insurance. It begins by discussing the Court's arguments regarding the mandate before turning to its modification of Medicaid. It then considers the problem of “severability” arising from the Court's intention to strike down the entire statute before concluding with an analysis of why Judge John Roberts voted as he did.