1. The Patient Protection & Affordable Care Act United States Court of Appeals for the Sixth Circuit (2011)

2.  Regulations on the Health Insurance Industry ◦ Coverage cannot be denied based on pre-existing conditions. ◦ Limitations on rate increases based on risk factors ◦ Students can maintain coverage on a parent’s policy until age 26. ◦ Creates online state health insurance marketplaces for individuals to easily compare and purchase policies.

3.  The Act mandates individuals purchase a minimum amount of healthcare coverage, or incur a penalty.  Plaintiffs argue the minimum coverage mandate harms them financially.  The plaintiffs argue the penalty for not purchasing the minimum coverage is an unconstitutional tax.

4.  Does Congress have the power to pass a law mandating individuals purchase insurance? ◦ Yes – Under the powers granted to Congress under the Commerce Clause of the Constitution.  Does Congress have power to regulate inactivity using this power? ◦ Yes – Congress has a “rational basis” to believe purchasing insurance, or lack thereof, effects interstate commerce.

5.  Congressional studies show an individual’s decision to buy health insurance affect commerce as a whole.  The decision to self-insure affects commerce as well.  Self-insured as a class are unable to pay for the services they receive.

6.  Wickard v. Filburn (1945) ◦ The Supreme Court upheld Congress’s power to regulate non-economic activity or inactivity when the action has a substantial effect on interstate commerce.  Gonzales v. Raich (2005)  United States v. Lopez (1995) ◦ “Those activities having a substantial relation to interstate commerce,... i.e., those activities that substantially affect interstate commerce.”

7.  The U.S. spends largest percent of GDP on health care in comparison to other major countries.  The U.S. spends the most money per capita on health care compared to other OECD countries.  In 2000; the U.S. ranked 37 th for quality of care according to the World Health Organization.

8. Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). http://www.cms.hhs.gov/NationalHealthExpendData/ Dollars in Billions: 5.2% 7.2% 9.2% 12.5% 13.8% 14.5% 15.4% 15.9% 16.0% 16.0% 16.1% 16.2% 16.6% 17.6%

9. Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350- en (Accessed on 14 February 2011).doi: 10.1787/data-00350- en Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.

10.  Individuals are not aware of the cost up- front.  Individuals do not determine their own needs, a physician does.  It’s not easy to compare prices.  Everyone wants the best care, regardless of cost.

11.  Cost-Shifting ◦ Treating uninsured patients shifts costs to insurance companies and households. ◦ Emergency care is more costly than preventative. ◦ In 2008 Congress found providing health care to uninsured cost over $48 billion dollars. ◦ A 2009 study showed 62% of bankruptcies are due to medical expenses. 75% of those are insured individuals.

12.  Encouragement to participate in the market ◦ Increase in market participants will lead to a decrease in price. ◦ Attempting to achieve “near-universal” coverage.  Opening the market to individuals who could not previously afford insurance. ◦ State online marketplaces match consumers with plans they can afford. ◦ More consumers purchasing in a group will reduce cost.  Remains private