Coons v. Lew

The Affordable Care Act does not preempt the Arizona Act, nor does it violate an individual's substantial due process rights.

Pursuant to the Affordable Care Act passed by Congress and signed by the President, all citizens must maintain “minimum essential [health care] coverage” or pay a penalty. Coons, a citizen of Arizona, was not exempt from the provisions of the Affordable Care Act and does not wish to purchase private medical insurance. Along with fellow plaintiff Novack, Coons challenged the establishment of the Independent Payment Advisory Board (“IPAB)” as well as the constitutionality of the mandate itself. The plaintiffs also sought a declaration that “the Arizona Act is not preempted by the Affordable Care Act.” The plaintiffs argue that the district court erred when it dismissed the plaintiffs’ challenges. The first item the Ninth Circuit discussed was whether the IPAB’s establishment violated Article I’s non-delegation principle. Novack contends that the IPAB will harm his future interests because he is a physician and his surgery practice in Arizona receives approximately 12.5 percent of its patient care payments from Medicare. He alleges that “because IPAB is empowered to make recommendations on reimbursement rates. . . his challenge is ripe because he will suffer financial harm as a result of IPAB’s recommendations.” The panel determined that although it is likely he would suffer future harm, that harm is highly speculative. The panel determined that Novack’s claim lacked the constitutional requirement of ripeness. The next issue the panel discussed was if the individual mandate violated Coons’ rights of substantial due process. The panel determined that Coons’ rights were not violated because he is still able to have the freedom to choose the type of insurance or pay a penalty. Lastly, the plaintiffs contend that the Affordable Care Act preempts the Arizona Act. The panel determined the Affordable Care Act is constitutional and has the same provisions as the Arizona Act. AFFIRMED in part, VACATED in part and REMANDED with instructions.