The public debate over health reform has generally focused on such matters as whether employers should be mandated to pay the health insurance premiums for their employees and what types of medical benefits must be covered. Thus far the debate seems to have sidestepped one legal thicket: do the various reform plans pending in Congress comply with the Constitution? While you might think that the drafters of the health reform bills would have carefully evaluated the requirements of our most fundamental law, at least one set of constitutional precepts seems to have escaped their attention. These neglected principles may be loosely categorized as federalism constraints. More precisely, they have been enunciated as flowing from the Tenth Amendment.