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Affordable Care Act Litigation: Overview of Florida Decision and Its Meaning

posted on Wed, Feb 9 2011 3:44 pm by Jane Perkins

Affordable Care Act Litigation

The Background

As in some other states, plaintiffs in Florida are challenging the constitutionality of the Affordable Care Act (ACA). The plaintiffs in the Florida case made several claims, but the two that appear to be significant include:

  • That the individual mandate (the requirement that everyone buy health insurance or pay a penalty) was unconstitutional because the Commerce power does not allow Congress to regulate economic “non-activity” – i.e, the choice not to buy health insurance; and
  • That the Medicaid expansion was unconstitutionally coercive because even though states aren’t required to participate in the program, they get so much money from the federal government to participate that it becomes a de facto requirement.

The Decision

The decision has four major elements to it.

  1. Judge Vinson determined that the individual mandate is unconstitutional. This was not surprising based on his statements and questioning throughout the case. This decision matches the Virginia case, but stands in contrast to two other Federal Court decisions.
  2. Judge Vinson denied the Medicaid coercion claim. This was somewhat foreshadowed by some of the Judge’s statements and decisions in the past months. A number of organizations including the American Public Health Association signed on to an amicus brief arguing for this outcome.
  3. Judge Vinson decided, in contrast to even the prior Virginia decision that the individual mandate was not severable from the rest of the ACA.  This means that Judge Vinson declared the entire ACA unconstitutional.
  4. Judge Vinson denied a request for injunctive relief to formally prohibit further ACA implementation. However the Judge indicated that he was opting not to rule for the injunction because his declaration that the ACA is unconstitutional should be sufficient to bar any Federal official from doing anything to implement the law.

The Outlook

This decision was not a huge surprise and doesn’t really alter the course the case will now take.  Barring a motion for expedited review of the case directly to the U.S. Supreme Court being filed and granted, the next step will be an appeal to the Circuit Court of Appeal and, after that, to the Supreme Court. Due to the earlier Virginia and Michigan rulings, this process has already been underway.

However, Judge Vinson’s ruling on severability and emphasis on the implications of his declaratory judgment raise questions regarding ongoing implementation of health reform. The Federal government clearly could not actually put the individual mandate into effect at this point – it doesn’t go into effect until 2014. It is unclear whether all other health reform implementation work would be barred by the declaratory judgment. In any event, to avoid the risk of being seen as noncompliant with a judicial order, the Federal government may ask that the decision be stayed, or put on hold until the appeals are completed.

Notably, State governments are not bound by this decision. Given the uncertainty of the final outcome and the limited window of time to implement reform, a state faces risks if it  stops implementation work. Potential consequences include loss of federal funding or federal control of State health insurance exchanges.

For  reasons states should consider continuing implementation, see NHeLP’s list of 10 Reasons to Say Yes To Implementation.

This information was developed by Jane Perkins, legal director for the Network for Public Health Law – Southeastern Region at National Health Law Program.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

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