Obamacare Not Violative of 'Medical Autonomy'

     (CN) - The Affordable Care Act's individual mandate does not violate an Arizona man's right to "medical autonomy," the 9th Circuit ruled Thursday.
     Plaintiffs Nick Coons and Eric N. Novack challenged several aspects of the health care law in a 2010 lawsuit, with the help of the Phoenix-based Goldwater Institute.
     Coons claimed that the act known popularly as Obamacare violated his rights to medical autonomy and privacy. Novak, a physician, argued among other things that the law's Independent Payment Advisory Board (IPAB), a 15-member panel tasked with monitoring Medicare spending, slighted several of his constitutional rights. Both plaintiffs sought a court ruling that the Arizona Health Care Freedom Act, a state law allowing citizens to ignore the individual mandate, was not preempted by the federal law.
     Two Republican members of the U.S. House of Representatives from Arizona, Jeff Flake and Trent Franks, joined in an amended version of the complaint but not in the appeal.
     U.S. District Judge G. Murray Snow stayed the case in Phoenix while the Supreme Court considered its landmark case from 2012, National Federation of Independent Business v. Sebelius. Snow subsequently ruled for the government defendants after the high court found the individual mandate constitutional. Snow also dismissed Coon's medical-autonomy and privacy claims as unripe for review, found unconvincing Novack's challenge to the IPAB, and ruled that the Arizona law was indeed preempted.
     A unanimous appellate panel affirmed most of the lower court's ruling Thursday, while vacating Snow's judgment on the IPAB for lack of jurisdiction.
     "The fact that the individual mandate forces Coons to expend funds on either medical insurance or a penalty implicates plaintiff's economic interests only-a substantive due process right abandoned long ago by the Supreme Court," wrote Judge Susan Graber for the appellate panel. "Contrary to Coons' contentions, the individual mandate does not force him into an intimate relationship with an intermediary insurer or preclude the doctor-patient relationship of his choice. He remains free to obtain medical insurance of his own choosing-or to obtain no insurance, but at a financial cost-and to use or not use any such insurance in selecting future doctor-patient relationships. To the extent that Coons simply wishes to remain uninsured and free from the mandatory payment, the Supreme Court no longer recognizes such a right as fundamental."
     The panel concluded as well that Coon's privacy claim was but a "speculative intrusion" and thus unripe for review.
     "Coons does not contend that he is currently at risk of being forced to disclose information protected by his substantive due process right, so a holding of unripeness would work no hardship against him," the ruling states. "Judicial resolution of this issue should await a concrete dispute."
     The panel also found that the Arizona Health Care Freedom Act clearly "stands as an obstacle to Congress' objective to expand minimum essential health coverage nationwide through the individual mandate," and so is preempted.
     Finally, while the district court had held that the establishment of the IPAB did not violate non-delegation principles, the appellate panel found that Novack's "allegations of future injury are too speculative to satisfy the constitutional requirement of ripeness," and vacated Snow's ruling in that respect.
     Goldwater Institute attorney Christina Sandefur called this element of the 9th Circuit's decision "disturbing" in an email to Courthouse News.
     "It leaves Americans at the mercy of an unaccountable board without vote of Congress, signature of the president, input from the public, or review by the courts," she said. "The Board's laws can affect all aspects of healthcare - public and private - since the ACA empowers IPAB to take any action it deems 'related to' the Medicare program. And since the law insulates IPAB's actions from judicial review, there is nothing anyone can do if the Board were to begin rationing care. "
     She added that the plaintiffs are "dedicated to fully prosecuting this case and are currently weighing the options - whether we will petition for an en banc rehearing, review by the Supreme Court, or file a new lawsuit once IPAB enacts its first law."