More than half of the twenty pages in the current decision are devoted to procedural issues. The judge found that both Thomas More Law Center, acting on behalf of its members, and several individual plaintiffs had standing to bring their request for an injunction. The court also overcame several other procedural hurdles before addressing the heart of the complaint: that the Health Care Reform Act, specifically the provision that mandates individual purchase of health insurance, is unconstitutional.
Plaintiffs alleged that requiring individuals to purchase health care is an impermissible extension of the interstate commerce clause, which has never before been used to regulate inactivity. The court conceded that looked at in that manner, this would be an issue of first impression, but went on to distinguish between ''economic activities'' and ''economic decisions''. The judge held that choosing not to buy health insurance was not a decision to not participate in the health care market but rather a choice about how to participate. By not buying insurance, individuals are choosing how to pay for health care, as opposed to choosing not to pay for health care. The court pointed out that unlike other economic decisions individuals make, such as deciding whether or not to buy a car, nearly everyone will at some point need some form of medical attention. By choosing not to purchase health insurance, it is reasonable for Congress to conclude that they are impacting the cost of health care and of health insurance premiums for everyone. By focusing on economic choices instead of economic actions, the court found that the individual mandate is consistent with past Supreme Court decisions regarding the commerce clause.
