That's true now but most of the legislation pending would largely do away with individual state insurance regulation (Baucus' bill seems to be the only exception and as Slate pointed out is very bipartisan--Republicans and Democrats hate it). The first effect of the legislation would be to nationalize health care regulation. This then yields the authority to Congress to regulate health care (under the Commerce Clause) in any way they see fit that stands under the Constitution. Is that circle? Yes. But it is a constitutional circle. There is no Constitutional obligation to be logical. :)