Senior Circuit Judge Laurence Hirsch Silberman, of the U.S. Appeals Court for the District of Columbia, writing for the majority, which upheld a lower court ruling that a mandate requiring people to purchase health care insurance is allowed under the U.S. Constitution:
“Because virtually everyone will, at some point, need health services, no one is truly inactive, and the health services market is inextricably intertwined with health insurance. Congress found that those who do not purchase health insurance, and instead self-insure, almost inevitably take health care services they cannot afford. Hospitals, by virtue of federal law and professional obligation, provide these services, and as a result, $43 billion in annual costs are shifted to the insured, through higher premiums. That, in turn, makes health insurance less affordable and increases the total number of uninsured. … Therefore, it is argued that Congress rationally concluded that decisions about how to pay for health care, in the aggregate, substantially affect interstate commerce.”
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