In the dystopic comic-book universe of Alan Moore and Dave Gibbons' Watchmen, where Richard Nixon is well into his fifth term and the U.S. is locked in a precarious nuclear detente with the Soviet Union, costumed superheroes are outlawed by the Keene Act. Law and the Multiverse explains that the Keene Act probably relies on a broad reading of the Commerce Clause, based on the Supreme Court's ruling in a 2005 case that goes to the center of the dispute over whether or not the Affordable Care Act is constitutional:
It should be noted that the fact that costumed adventurers actually provide their service for free and often without contracting with clients is of no account, as is the fact that they may work only within one state. The Commerce Clause extends to non-commercial transactions and even intra-state activities as long as doing so is necessary to make the interstate regulation effective. Gonzales v. Raich, 545 U.S. 1 (2005). If the local or non-commercial activity affects the interstate market, the Commerce Clause can reach it. 545 U.S. at 19. The existence of costumed adventurers no doubt affected the market for regular security firms, private investigators, and bounty hunters. If the aggregate impact on the market was substantial or significant, then that is enough. Id. at 19-20.
This may seem like an extreme take on the Commerce Clause, but let us recall that this is the same universe in which Richard Nixon essentially became President-for-Life. The federal government of the Watchmen universe is likely to be very powerful indeed, and that means a broad Commerce Clause.
In Watchmen, the only people who support the remaining costumed vigilantes and presumably oppose the Keene Act are the hard-core right-wingers who write for the New Frontiersman. So even if the Republican Party as a whole has adopted a broad reading of the Commerce Clause in partisan solidarity with Nixon, there are still a few conservatives holding out.
Still, it sounds like in the universe of Watchmen, defending the Affordable Care Act would probably be a breeze. As opposed to reality, where Antonin Scalia might just change his mind about his concurrence in Gonzales and overturn the law because Republicans really hate it.