Five key questions for the Supreme Court to consider in a healthcare decision: Page 6 of 6

Why does the mandate exist?

While framing the mandate as a way to regulate the healthcare market, the government says the purpose of the mandate is to crack down on “free riders” — uninsured people who go to the hospital and can’t pay their bills, passing the cost of their care on to taxpayers and people with insurance.

But if that’s the idea, Chief Justice John Roberts asked, shouldn’t people be able to satisfy the mandate with a policy that only covers catastrophic care? The healthcare law requires much more robust benefits, including services like maternity care, which many people will never need.

The mandate’s other purpose is to bring young, healthy people into the system, offsetting the cost of requiring insurance companies to cover sick people. But in that context, it’s linked more directly to the insurance market.

“This statute undeniably operates in the health insurance market,” Clement said. “And the government can't say that everybody is in that market. The whole problem is that everybody is not in that market, and they want to make everybody get into that market.”

Five questions that could shape the court’s ruling:

  1. Is this about healthcare or health insurance?
  2. Where do the mandates stop?
  3. What constitutes an “activist” approach?
  4. What happened to the Necessary and Proper Clause?
  5. Why does the mandate exist?