A lot of people have been complaining that LeBron James is struggling in the NBA Finals. Based on yesterday’s oral argument in front of the 11th Circuit Court of Appeals in the main Obamacare constitutional challenge, I’m starting to feel the same way about Paul Clement, who is literally regarded as the LeBron of Bush administration lawyers: the best constitutional advocate of his generation.
I agree with most commentators that the three-judge panel, comprised of two Clinton appointees and a George H. W. Bush appointee, appeared quite skeptical of the constitutionality of the individual mandate. But Paul Clement, who represented the states, and Michael Carvin, who represented the National Federation of Independent Business, made a number of unforced errors in their defense of Roger Vinson’s lower court ruling that Obamacare was unconstitutional in its entirety.
Specifically, while it’s true that acting Solicitor General Neal Katyal was “on the ropes” for most of the discussion of the individual mandate, it was Clement and Carvin who were on the defensive when challenged on whether or not the mandate could be severed from the rest of Obamacare, leaving the remainder of the law intact.
And, while it’s perhaps asking too much for constitutional lawyers to bone up on health policy, Clement and Carvin largely conceded that Obamacare’s individual mandate would help solve the “free-rider problem,” implicitly justifying its constitutionality under the Necessary and Proper Clause, when in fact Obamacare will worsen the free-rider problem.
With regards to severability, Judge Frank Hull and others repeatedly asked the plaintiffs: Did they really believe that every provision of Obamacare would be adversely affected if the individual mandate was overturned? Their answer was, implausibly, yes. But this is plainly silly: Is, for example, the federal takeover of the student loan program, contained within PPACA, substantially affected if the individual mandate is overturned? It’s doubtful.
Judge Vinson, in his lower court ruling, made a far more reasonable case. He conceded that “in a statute that is approximately 2,700 pages long and has several hundred sections — certain of which have only a remote and tangential connection to health care — it stands to reason that some (perhaps even most) of the remaining provisions can stand alone and function independently of the individual mandate.” But Vinson pointed out that judges are not equipped to “try to infer Congress’ intent” and become health policy wonks (emphasis added):
However, the question is not whether these and the myriad other provisions can function as a technical or practical matter; instead, the “more relevant inquiry” is whether these provisions will comprise a statute that will function “in a manner consistent with the intent of Congress.” See Alaska Airlines, Inc. v. Brock, 480 U.S. 678, 685, 107 S. Ct. 1476, 94 L. Ed. 2d 661 (1987) (emphasis in original). Thus, the first step in the severability analysis requires (at least to some extent) that I try to infer Congress’ intent. Although many of the remaining provisions, as just noted, can most likely function independently of the individual mandate, there is nothing to indicate that they can do so in the manner intended by Congress. The analysis at the second step of the severability test makes that conclusion pretty clear.
With regards to the free-rider problem, only at one point did either Clement or Carvin attack the individual mandate on policy grounds: Carvin pointed out that the amount of health-insurance subsidies provided by Obamacare exceeded the amount of money we currently spend on uncompensated care. (For example, in Massachusetts, Romneycare has reduced uncompensated care spending by about $250 million, but the law’s insurance subsidies cost $830 million and are rapidly growing.)
There is an even greater flaw in the “free-rider” argument. The only reason that we have a free-rider problem in the first place is because Congress passed a law in 1986, called the Emergency Medical Treatment and Active Labor Act, or EMTALA, forcing hospitals to provide free emergency care to anyone who needs it, including illegal immigrants, without regard to their ability to pay. It makes little sense that an otherwise unconstitutional provision (the individual mandate) suddenly becomes constitutional because Congress passed EMTALA.
Constitutional arguments shouldn’t require a discussion of the intricacies of health policy. But the core of the pro-Obamacare case is a policy argument: that the individual mandate is a necessary component of Congress’ efforts to improve our health-care system. This argument is plainly false, and Clement and Carvin need to make that clear.
— Avik Roy is an equity research analyst at Monness, Crespi, Hardt & Co., and blogs on health-care policy at The Apothecary. You can follow him on Twitter at @aviksaroy.
Regarding EMTALA, I heard the part where the plaintiffs argued that healthcare isn't a more special case than food or other essentials. The snippy judge responded that there isn't significant cost-shifting caused by uncompensated taking of food from grocery stores. It sounds like congress could force us to buy specific food if they first pass a law saying stores have to supply food to people. Bizarre.
Reply to this commentLinkReport AbuseThe judges where clearly asking about the healthcare provisions when talking about severability ... to point at the student loan provision as clearly not effected by the mandate is silly ... you will note that none of the judges made such a leap of nonsense ...
I guess being a health care analyst is not the same as being a lawyer ...
Reply to this commentLinkReport AbuseHi Dorsai,
The lawyers were asked: what provisions do you consider to be critically tied to the mandate? The lawyers, essentially, refused to answer. What they should have said was, "it's not our role as judges and lawyers to divine which provisions will be more or less affected by severing the mandate, which is why the mandate is unseverable."
Reply to this commentLinkReport AbuseMr. Roy,
Should we then be steeling ourselves for a bad outcome or can you get your points across to Messrs Clement and Carvin as well, but in a more direct fashion?
Reply to this commentLinkReport AbuseIt's always tough to extrapolate from oral argument, but my guess at this point is they might overturn the individual mandate, and possibly a few other explicitly related provisions (guaranteed issue and community rating), but uphold the rest of the law.
My hope is that Clement et al. consider the policy issues more rigorously if and when this gets to the Supreme Court.
Reply to this commentLinkReport Abuse"...Clement and Carvin largely conceded that Obamacare’s individual mandate would help solve the “free-rider problem,” implicitly justifying its constitutionality under the Necessary and Proper Clause..."
I'm not a lawyer, so this may be an incorrect observation; whether or not Obamacare solves the "free-rider" problem is completely and wholly separate from the constitutionality of the mandate. We can have policy debates all day long where constitutionality is never in question. And we can have (and surely do have) very bad policies that don't violate the Constitution.
So I don't get this assertion that Clements and Carvin implied the mandate was within the boundaries of the Constitution simply by agreeing Obamacare would solve a policy problem.
Reply to this commentLinkReport AbuseThe policy argument matters, because it is the argument that the mandate is critically important to sound health-care policy that is at the heart of why, in the Obama administration's eyes, the law should be upheld. Yes, policy should in theory be irrelevant, but the courts have strayed far from the Founders in this respect.
Reply to this commentLinkReport AbuseThe Necessary and Proper Clause is not a clause with independent authority to "solve" the "free rider" problem. Rather, it is a phrase that only references the work needed for the specified powers of Congress and as Vinson cites Hamilton clarifying, "only (a) declaratory of a truth, which would have resulted by necessary and unavoidable implication from the very act of constituting a federal government, and vesting it with certain specific powers".
The argument was well addressed by Vinson when he observed that, following the Government's argument to its logical end, "rather than being used to implement or facilitate enforcement of the Act’s insurance industry reforms, the individual mandate is actually being used as the means to avoid the adverse consequences of the Act itself. Such an application of the Necessary and Proper Clause would have the perverse effect of enabling Congress to pass ill-conceived, or economically disruptive statutes, secure in the knowledge that the more dysfunctional the results of the statute are, the more essential or “necessary” the statutory fix would be. Under such a rationale, the more harm the statute does, the more power Congress could assume for itself under the Necessary and Proper Clause."
Seen in this light, the government’s argument justifying the individual mandate through the Necessary and Proper Clause is absurd circular reasoning.
Reply to this commentLinkReport AbuseMr. Roy: stick to equity research analysis and leave the lawyering for the lawyers. One cannot prove something "false" at an appellate hearing because appellate judge have no power to make factual findings. You can only prove that some action is or is not consistent with existing law, not that it does or doesn't happen. Factual assertions are disproved at the trial level.
Reply to this commentLinkReport AbuseHi Dave,
I'm aware of the fact/law distinction between lower courts and appellate courts. However, if you listen to the hearing, you will see that these issues of policy come up repeatedly.
Reply to this commentLinkReport AbuseOne problem with oral argument is that not uncommonly the justices give the hardest time to the side they tend to favor. So, no particular reason to light the fireworks just yet.
As to the rest, it's hard to second-guess attorneys in argument, but it does sound like their preparation was half-hearted. The answer to the question of severability is simple: the statute does not say the individual mandate is severable. This is because Obama knew that it is essential to the plan and did not want to invite the courts to sever it in order to save the rest.
If the court in fact believes the individual mandate is an unwarranted expansion of federal power (compelling people to buy a product) then it is most likely that they will find a way to sever it in order to "save" the legislation as a whole. The only answer is going to be in 2013 when a conservative House and Senate can repeal the whole mess. How long it will take us to dig out from the financial abyss this act has created is anybody's guess.
Reply to this commentLinkReport AbuseI don't know about you but all this worrying about keeping health insurance is making me sick!! I think that giving people the stability and security of knowing that they have access to medical care regardless of income level is liberating in itself. How can the federal government mandate that children go to school until they are sixteen or that state governments mandate that we carry liability insurance on my vehicle or that I pay income taxes or real estate taxes etc., etc.? Sure, you don't have to do these things and maybe get away with it but there has to be some sort of regulation with things that support a civil society. I am for it.
Reply to this commentLinkReport AbuseGet your filthy stealing hands out of my pocket. Nothing about your desire to spend the money I earn entitles you to take it from me. The Constitution has NO provision for Government to take any personal action for the "Common Welfare." Read the document. Get an education. Stop stealing from your fellow citizen.
Reply to this commentLinkReport AbuseStates mandate school attendance, consistant with the constitution, 10th Amendment:
"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."
And if you choose to exercise the "privilege" of driving, states require you to have a license and carry insurance. If you exercise a right, states cannot require such of you.
Reply to this commentLinkReport AbuseMy prediction is that all the appeals courts and ultimately the Supreme Court will uphold the individual mandate and most of the other provisions. Getting rid of this monstrosity will be done in only one way - by winning in the 2012 election.
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