The head of one of the largest private foundations in the United States, the California Endowment, explains how it came to the decision to show its support for the constitutionality of the federal health reform act.

Nearly everyone would agree that greater access to health care for all Californians is a good thing. As the nation’s most populous state, California is also, coincidentally, the state with the most uninsured people—more than 6.9 million uninsured adults and children. Let’s face it: if all of those people were to have a major medical crisis, the costs to the health care system and to society would be astronomical. In fact, the reality is that national costs are already remarkable: uncompensated medical care of uninsured persons was estimated at $62.1 billion for 2009.

The core of the California Endowment’s mission is to expand high-quality health care to all Californians, and to achieve that, we need better and more affordable access to health care, particularly for those in working class, underserved, and low-income communities. That’s why the California Endowment, by way of Kathleen Sullivan, an esteemed Supreme Court litigator, acted on clear legal ground in filing a second amicus brief with the U.S. Supreme Court in support of the constitutionality of the Affordable Care Act of 2010. This second brief strengthens the data and information found in our first brief supporting the constitutional argument referring to the minimum coverage requirement (or individual mandate) found in the federal health reform law.

As a backdrop, the Endowment sponsors social science and public policy research that increasingly provides evidence to policy makers and consumers about the benefits of expanding access to affordable, high-quality health insurance. We were compelled to share this wealth of research that contends that the inclusion of the minimum coverage requirement in the Affordable Care Act, which would drastically reduce the number of uninsured and reduce spiraling health care costs, is perfectly within Congress’s authority under the Commerce Clause of the U.S. Constitution.

The Supreme Court has repeatedly reaffirmed that Congress has broad authority to regulate interstate commerce. As such, the Affordable Care Act’s regulation of the distribution, purchase, and consumption of health services—economic activities that make up 17.6 percent of gross domestic product—falls squarely within allowed Commerce Clause regulation. The key connection here is that the failures in the health care market—high, uncompensated costs—are tangibly linked to commerce, so the federal health reform law, which includes a mandate on minimum coverage, is Congress’s attempt to address that failure. And the minimum coverage requirement would, indeed, have corrective properties: it would expand the pool of the newly insured by at least 2 million in California alone.

The California Endowment felt no hesitation in getting involved with this important issue, for the principal reason that the Affordable Care Act will be a huge catalyst in reforming the broken health care system as we know it. Many people are already benefiting from its provisions: seniors are getting help paying for medications, young people are able to stay on their parent’s health coverage policy up to age twenty-six, and parents are able to get health coverage for their children who were previously denied it because of a pre-existing condition. And in 2014, the health reform law will expand access to public and private health coverage to millions of Americans—many of whom are struggling right now to get the medical care they need. For those Americans, 2014 can’t come too soon.