Contained in the Healthy San Francisco program is a mandate on employers in San Francisco to offer health insurance coverage to their employees. If failing to do so, the employer can meet the requirement by paying into the public program. Small employers and non-profits are exempt. A very similar approach was adopted in many of the national health care reform proposals. The Golden Gate Restaurant Association unsuccessfully challenged this requirement in the 9th U.S. Circuit Court of Appeals in 2008.
Today, the US Supreme Court decided to not hear the final appeal from the Restaurant Association, ending their battle to eliminate this employer mandate.
While the questions raised by the city-wide employer mandate is far from the federal and constitutional questions raised in the court cases involving national health care reform, the Supreme Court’s willingness to throw aside such a hotly debated issue involving health insurance mandates points to the current vision of the Court. The Restaurant Association may not have had the strongest legal argument to eliminate a mandate, but the Supreme Court has shown hesitancy to fully address the issues surrounding insurance mandates.
The Association argues the mandate violates federal law, rather than a Constitutional debate like that of the State Attorney General’s case against national reform. The fact that the Court defended state law over federal restrictions does not hurt the proponents of health reform and the constitutionality of national reform. These are separate questions on federal versus state powers. In fact, a repeal of the San Francisco employer mandate would have hurt the case for the Attorney Generals. It would have been a blow to the health insurance regulatory power of the states, in favor of federal law. So in this case, conservatives hoping for a repeal of health reform should have been rooting for San Francisco. I imagine that image does not appear likely.
But like I said, these are very different issues, with a great deal of nuanced differences. Health reform does not limit a state’s ability to set mandates and create additional regulations for insurers. The employer mandate in San Francisco is designed very differently in terms of penalty than national health reform.
This is why, the most important piece to look at is the attitude of the Supreme Court. While the individual and employer mandate are very different under a microscope, they are one of the few health insurance mandates that currently exist in this country. Legal reactions to mandates are important, because there is relatively few legal decisions and little history behind such laws.
The Supreme Court’s desire to avoid this specific issue of insurance mandates gives hope to defenders of health reform that a case against a similar individual mandate will also be refused.