Dr. Lee Sanders examines Aalliyah Negron, 6, as her sister Jensenia Bonilla,… (Joe Raedle / Getty Images )
President Obama's healthcare overhaul survived its first test before a federal appellate court, as the U.S. 6th Circuit Court of Appeals in Cincinnati concluded that the law's insurance requirement is constitutional.
"We find that the minimum coverage provision is a valid exercise of legislative power by Congress under the Commerce Clause," a 2-1 majority of the panel concluded, rejecting a challenge by the conservative Thomas More Law Center.
Notably joining the majority opinion was Judge Jeffrey Sutton, an appointee of President George W. Bush and a former law clerk to conservative Supreme Court Justice Antonin Scalia.
Sutton is the first Republican appointee on the federal bench to affirm the constitutionality of the so-called individual mandate.
The Thomas More lawsuit has not attracted as much attention as two other legal challenges being pushed by GOP state officials in Virginia, Florida and other states. Those suits are being reviewed by federal appellate courts in Atlanta and Richmond, Va.
Most legal experts and other litigants involved in healthcare lawsuits expect the fate of the Patient Protection and Affordable Care Act that Obama signed last year will ultimately be settled by the U.S. Supreme Court, possibly next year.
"While the decision in the 6th Circuit Court of Appeals is disappointing, it is only the first of several opinions we expect on the constitutionality of the law in the coming months," Karen Harned, executive director of the National Federation of Independent Business Small Business Center, said in a statement. The NFIB is challenging the law in the Florida lawsuit.
The 6th Circuit's opinion, and particularly Sutton's participation, nonetheless marked a notable legal victory for the Obama administration and its allies, who have asserted that Congress had the authority to require Americans to get health insurance starting in 2014.
The administration has said this was a form of regulating commerce because a person's decision not to obtain health insurance imposes a cost on others who inevitably end up subsidizing medical care for the uninsured.
Sutton effectively accepted that reasoning in his opinion, which concurred with Judge Boyce F. Martin, an appointee of President Carter who also upheld the law.
"No one is inactive when deciding how to pay for healthcare," Sutton wrote, rejecting the argument by critics of the law that Congress could not regulate "inactivity" such as the decision not to get health insurance, or to self-insure.
"Self insurance and private insurance are two forms of action for addressing the same risk," he wrote. "Each requires affirmative choices."
Many healthcare experts believe an insurance mandate is critical to guaranteeing all Americans can get insurance, a right provided by the new law. Without such a requirement, people would be able to wait until they are sick to buy insurance, pushing up premiums.
Critics of the law contend, however, that the unprecedented insurance requirement tramples on individual liberty and opens the door to other government mandates.
Judge James Graham, who was appointed by President Reagan, reiterated that concern in his dissent Wednesday.
"If the exercise of power is allowed and the mandate upheld, it is difficult to see what the limits on Congress' Commerce Clause authority would be," he wrote, defending the role of the courts to restrain lawmakers.
Whether the Supreme Court will agree remains unclear. Sutton closed his opinion with a pointed defense of the kind of judicial restraint often championed by conservatives.
"Time assuredly will bring to light the policy strengths and weaknesses of using the individual mandate as part of the national legislation, allowing the peoples' political representatives, rather than their judges, to have the primary say," Sutton wrote.