Why the Individual Mandate for Health Insurance Is Constitutional

Yale law professor Jack Balkin explains further in his "Perspective" piece in this week's NEJM.

Balkin's overarching argument is that the requirement to purchase health insurance, described in both the House and Senate forms of the healthcare reform bill, is really a tax* on those persons** who fail to purchase health insurance. And, according to the Constitution, Congress has the power to legislate taxes that serve the general welfare. End of story.

Balkin predicts that the Supreme Court won't even touch the health-insurance mandate/tax issue, unless a federal court of appeals knocks it down. And in that case, the high court will uphold it.

* In the House version of the bill, the income of the uninsured is taxed; in the Senate version, an uninsured individual is taxed on an event basis--meaning, he is taxed each month that he doesn't purchase health insurance.

** Meaning individuals who don't already have employer-provided health insurance. The "mandate" also does not apply to dependents, Medicare or Medicaid recipients, military families, overseas ex-pats, or religious objectors.

Off-topic addendum: In the Age of Transparency, the NEJM has evidently found a way to avoid the multiple columns of small type that are sometimes necessary to print all of the disclosures of its published authors. Provide an online link instead to the author's filled-out disclosure form.