As the Obama Administration works toward implementing the contentious individual insurance mandate in the Affordable Care Act (ACA), a federal appeals court on Feb. 1, 2013 upheld the constitutionality of the key provision in the 2010 health reform law, which requires most Americans to maintain health insurance or pay a penalty beginning in 2014.

Leading the suit in U.S. Citizens Association v. Sebelius, Nos. 11-3327/3798 (6th Cir. Feb. 1, 2013) were a nonprofit association and several of its members who were among the early challengers to the mandate. The Supreme Court ultimately ruled in National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566 (2012) that Congress possessed the authority under its constitutional taxing power to enact the mandate and its accompanying penalty, but it left unresolved questions regarding whether the mandate violated the individual rights protected by the Constitution’s Bill of Rights. According to the plaintiffs in U.S. Citizens Association, the mandate did infringe these rights—specifically, their rights to expressive and intimate association under the First Amendment, right to liberty under the Fifth Amendment, and right to privacy under various amendments, including the First and Fifth Amendments.

The U.S. Court of Appeals for the Sixth Circuit, however, disagreed. In each strand of its analysis, the court emphasized that the mandate only requires individuals to maintain a minimum level of health insurance or pay a penalty. Contrary to the plaintiffs’ assertions, the court held, the mandate did not intrude upon their selection of care providers or their ability to express disapproval of the ACA or health insurance generally in violation of their respective rights to intimate association and expressive association. Nor, according to the court, did the mandate dictate the terms of the plaintiffs’ medical care or compel them to disclose their personal medical information to insurance companies in violation of their respective rights to liberty or privacy.

The Sixth Circuit’s ruling marks one less obstacle for the Obama Administration as it moves forward in implementing the mandate. On the same day that the court released its opinion, the Internal Revenue Service published a proposed rule that provides guidance on liability for and computation of penalty payments under the mandate, the minimum health insurance that individuals must maintain, exemptions from the mandate, and procedures to ensure compliance. The rule is open to public comments until May 2, 2013.