There is a rational basis to conclude that, in the aggregate, decisions to forego insurance coverage in preference to attempting to pay for health care out of pocket drive up the cost of insurance. The costs of caring for the uninsured who prove unable to pay are shifted to health care providers, to the insured population in the form of higher premiums, to governments, and to taxpayers. The decision whether to purchase insurance or to attempt to pay for health care out of pocket, is plainly economic. These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers, and the insured population who ultimately pay for the care provided to those who go without insurance. These are the economic effects addressed by Congress in enacting the Act and the minimum coverage provision.The decision, in simpler terms, is this. Unless a person opposes the medical establishment on religious grounds, that person will at some point avail himself of services provided by the health care market. That person, at the time of service, may not be able to pay for the service. Therefore, that person's original refusal to participate in the market by purchasing insurance constitutes economic activity (because if he can't pay, his costs will be shifted to other participants) which the congress may regulate under the commerce clause. In even more simple terms, refusal to participate in an economic activity constitutes an economic activity that congress may regulate.
The health care market is unlike other markets. No one can guarantee his or her health, or ensure that he or she will never participate in the health care market. Indeed, the opposite is nearly always true. [...]
The plaintiffs have not opted out of the health care services market because, as living, breathing beings, who do not oppose medical services on religious grounds, they cannot opt out of this market. [...]
I want to address the mental gymnastics undertaken by the judge in arriving at this decision, e.g. that a person can't not get sick; that a person, once sick, can't avoid the health care market; and the fact that that person may not be able to pay means that he can be forced to buy insurance. I'm not going to, though. At least, I'm not going to any more than I just did.
Instead, I'll focus solely at the situation in which a person does get sick, does avail himself of the health care market, and can't pay for the service(s) since that is the situation on which the judge's upholding of the PPACA is based. So, what happens when an uninsured person arrives at a hospital emergency room? Under the EMTALA, that person must be treated. Nobody [explicitly] pays for this treatment, though. The federal government has mandated that hospitals treat such patients but does not reimburse them for these costs. Instead, hospitals can write this cost off as charity or bad debt on their taxes. They can also shift these costs to paying customers in the form of higher charges for service. (Note, too, that there is nothing preventing a hospital from doing both.)
So, the judge is correct that caring for uninsured patients creates additional costs for taxpayers (in the form of tax deductions taken by hospitals) and for paying participants in the health care market (in the form of increased costs for service). Here's the rub, though. The government created that additional cost in the first place by passing the EMTALA! The absurdity of trying to fix the problems created by government interference in the market by further interfering in the market should be obvious to everyone. The problem is more insidious than that, however.
The government has dropped all pretense of "legally" taking people's money via taxation. It is now explicitly assuming the ability to force people to spend money in the ways that it directs and is using its own policy as an excuse for the authority. By this logic, there is nothing that the government cannot regulate. The total state has arrived.