"It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not 'acting,' especially given the serious economic and health-related consequences to every individual of that choice," Kessler writes. "Making a choice is an affirmative action, whether one decides to do something or not do something. They are two sides of the same coin. To pretend otherwise is to ignore reality."
Kessler, however, rejected the argument that Congress had the authority to enact the Affordable Care Act under the General Welfare Clause because Congress "did not intend [the law] to operate as a tax."
The Justice Department welcomed the ruling, which was the "third time a court has reviewed the Affordable Care Act on the merits and upheld it as constitutional," a spokeswoman said in a statement.
"This court found -- as two others have previously -- that the minimum coverage provision of the statute was a reasonable measure for Congress to take in reforming our health care system," DOJ's Tracy Schmaler said. "At the same time, trial courts in additional cases have dismissed numerous challenges to this law on jurisdictional and other grounds. The Department will continue to vigorously defend this law in ongoing litigation."