One down… at least two more to go. Yesterday, a U.S. Court of Appeals panel in Cincinnati gave round one of the fight over the Patient Protection and Affordable Care Act to the White House, upholding a lower court ruling that a stipulation in the law that requires Americans to purchase health insurance does not violate the Constitution.

Writing for the majority in the 2-1 decision, Judge Jeffrey Sutton explains, “In my opinion, the government has the better of the arguments… Not every intrusive law is an unconstitutionally intrusive law.”

Arguments over the law have already been heard by five lower courts, with three courts upholding the act while two rejected it as unconstitutional. Yesterday’s decision upheld the decision of a Federal District Court judge in Detroit.

The majority judges gave two reasons why they believe the insurance mandate is constitutional and falls under the umbrella of the Commerce Clause:

First, the provision regulates economic activity that Congress had a rational basis to believe has substantial effects on interstate commerce… In addition, Congress had a rational basis to believe that the provision was essential to its larger economic scheme reforming the interstate markets in health care and health insurance.

The judges held that one’s decision to not purchase health insurance qualified as an act that has a direct impact on interstate commerce, by shifting the cost of the uninsured person’s medical care on to others. “The activity of foregoing health insurance and attempting to cover the cost of health care needs by self-insuring is no less economic than the activity of purchasing an insurance plan,” wrote one judge.

The lone dissenter on the panel thought that this is too broad of an application of the Commerce Clause, stating that, should the insurance mandate come to pass, “it is difficult to see what the limits on Congress’s Commerce Clause authority would be.”

There are still two more courts of appeal — one in Richmond, VA, and another in Atlanta — that will issue rulings on this matter. But it seems like the matter is fated to end up at the feet of the nine Supreme Court justices as early as October.

Round 1 in Appeals of Health Care Overhaul Goes to Obama [NY Times]

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