The provision of President Obama's health care reform law that mandates individual purchase of health insurance coverage has been deemed constitutional by the U.S. Court of Appeals for the Sixth Circuit. This marks the first appellate court ruling on the Patient Protection and Affordable Care Act's hotly contested "minimum coverage" provision, which requires most Americans to obtain health insurance beginning in 2014 or pay a penalty.

According to Judge Boyce Martin Jr., who wrote the Ohio-based court's 2-1 majority opinion, the provision is "a valid exercise of Congress' authority under the Commerce Clause."

"First, the provision regulates economic activity that Congress had a rational basis to believe has substantial effects on interstate commerce," wrote Martin. "In addition, Congress had a rational basis to believe that the provision was essential to its larger economic scheme reforming the interstate markets in health care and health insurance."

Robert Cabaj, M.D., chair of APA's Council on Advocacy and Government Relations, told Psychiatric News that the ruling can be viewed as a "crucial step" toward full passage of the health care reform law.

"The more momentum we get, the more progress we make," Cabaj said. "Presumably, the Supreme Court can use this decision as a base upon which to build its opinion."

While Martin, a Democratic appointee, was expected to support the reform-law provision, many detractors of the legislation were surprised by the concurring opinion of Judge Jeffrey Sutton, an appointee of President George W. Bush. In five previous U.S. District Court cases questioning the constitutionality of the Patient Protection and Affordable Care Act, the judges' rulings have adhered to the leanings of their appointing parties.

Sutton maintained in his written opinion that "not every intrusive law is an unconstitutionally intrusive law," even though he acknowledged that a favorable ruling in the case could set a precedent for Congress to mandate citizen participation in other programs and activities.

David Yerushalmi, the attorney for the lead plaintiff, the Thomas More Law Center, told the Washington Post that he sees the wording of Sutton's opinion as deferring a final ruling on the matter to the Supreme Court. Yerushalmi also informed the Post that he has begun drafting a petition to the high court.

Judge James Graham, a Republican-appointed U.S. District Court officiate temporarily assigned to the Sixth Circuit, wrote the court's sole dissenting opinion. Like Sutton, Graham voiced concern about a favorable ruling's effect on future cases related to the role of government in the lives of U.S. citizens.

"To approve the exercise of power would arm Congress with the authority to force individuals to do whatever it sees fit,... as long as the regulation concerns an activity or decision that ... can be said to have some loose ... economic connection, which nearly all human activity does," wrote Graham.

The U.S. Courts of Appeal for both the fourth and 11th circuits also heard arguments earlier this year in cases calling into question the health care reform law's constitutionality. According the Post, the appellate court rulings will likely be delivered within the next few months. The Supreme Court is expected to weigh in with a decision on hearing the issue once the appellate opinions are made public.

The Sixth Circuit opinion is posted at <www.ca6.uscourts.gov/opinions.pdf/11a0168p-06.pdf>.