Health care reform in the courts

Last week a Florida judge allowed parts of a lawsuit challenging the constitutionality of the Patients Protection and Affordable Care Act to go forward.  That received a lot of press attention and chest thumping by those who want to repeal national health care reform.

Earlier judges in Marland, California and Michigan dismissed cases challenging the new law so Florida was a big deal to the “repeal and replace” folks.

Political Correction, a project of Media Matters Action Network, has compiled a jargon-free document regarding the Florida judge’s ruling and what it means going forward.  Read the document below and be informed.

The Impact Of The Florida Judge’s Ruling On
Health Care Reform And Other Pending Lawsuits

On October 14, 2010, United States District Court Judge Roger Vinson issued an order that allows Florida and twenty other states to continue with their lawsuit challenging the constitutionality of the Patient Protection and Affordable Care Act (PPACA). This comes after United States District Court Judge George Steeh dismissed the lawsuit brought by the conservative Thomas More Law Center. Judge Steeh found the individual mandate to be constitutional, citing precedential authority and congressional intent. These differences amongst the judicial circuits foreshadow the long battle that proponents of the PPACA will face in the coming months.

Order And Opinion Overview

Four Counts Of The States’ Lawsuit Were Dismissed…

Count Two: Challenge To The Individual Mandate On Substantive Due Process Grounds.

The States’ Argument: The states attempted to argue that the individual mandate provision deprived citizens of their life, liberty, and property by requiring them to purchase health insurance.

The Judge’s Ruling: The judge ruled that the plaintiffs failed to state a claim for this count due to the fact that the individual mandate does not “implicate fundamental rights.” In other words, invoking the individual mandate does not deprive United States citizens of their life, liberty, or property. He also explained that the legislation is “rationally related to a legitimate end.” This is a standard of review in Constitutional Law known as the “Rational Basis Test,” in which there must be a showing that the legislation is rational and that it is related to a legitimate purpose. This is a very low standard of proof.

Count Three: Violation Of Constitutional Prohibition Of Unapportioned Capitation Or Direct Tax.

The States’ Argument: Here, the states’ argument is that the individual mandate provision is a tax, and that Congress is prohibited from directly taxing United States citizens.

The Judge’s Ruling: The judge immediately dismissed this count in his initial analysis because he found that the penalty for non-compliance with the individual mandate is not a tax. Thus, the states had no claim.

Count Five: Coercion And Commandeering As To Healthcare Insurance.

The States’ Argument: In this count, the states claimed that the provision in the PPACA that requires the states to set up health exchanges amounted to coercion.

The Judge’s Ruling: The judge threw out this claim because the states have the “choice” to set up the exchanges. If a state chooses not to do so the federal government will administer the exchange in that state.

Count Six: Interference With State Sovereignty As Employers And Performance Of Governmental Functions.

The States’ Argument: This claim is the infamous “Tenther” argument that frames states’ rights against federal government’s involvement. The states claim that the federal government cannot interfere with the with state government functions (i.e. enforcing the health exchanges and other provisions of the PPACA).

The Judge’s Ruling: The judge explained that because the PPACA will affect both public government and private employers it is a law of general applicability. This means that even if it isn’t “per se constitutional” it is still a valid law.

Two Counts Of The States’ Lawsuit Will Proceed…

Count One: Challenge To Individual Mandate As Exceeding The Commerce Clause.

The States’ Argument: The states’ argument is that the federal government is trying to regulate something that is “inactivity,” which is beyond the scope of their power. This is the critical argument to the States’ case.

The Judge’s Ruling: The judge felt that, at this stage in the litigation, both sides need to offer more arguments and proof of the impact. Under the Commerce Clause, Congress is only allowed to regulate the channels, instrumentalities, and activities of commerce. The judge ruled that because this argument is unprecedented he needs more information to make a ruling on the issue. He also added: “Of course, to say something is ‘novel’ and ‘unprecedented’ does not necessarily mean that it is ‘unconstitutional’ and ‘improper.’”

Count Four: Coercion And Commandeering As To Medicaid.

The States’ Argument: This is another essential claim for the states’ lawsuit. The states argue that the changes to Medicaid go beyond the scope of the Congressional power to spend for the general welfare of the public.

The Judge’s Ruling: The judge evaluated whether Congress exceeded its Spending Power by including provisions in the PPACA that would expand Medicaid in the states. The judge explained that the states have two choices — accept changes to Medicaid or withdraw from the system entirely — the latter of which would result in loss of funding and leave thousands of the poorest individuals in the country uninsured. For this reason, he ruled that the states’ claim is plausible and that this provision could amount to coercion.

[Florida et. al v. Department of Health and Human Services, Order and Memorandum Opinion, 10/14/10]

What To Expect Next…



Parties File Motion For Summary Judgment/On or before November 4, 2010
Opposing Party Responds/On or before November 23, 2010
Moving Party Replies to the Response/On or before December 6, 2010
Hearing on Motion For Summary Judgment/December 16, 2010

Final Points

Future Lawsuits Will More Than Likely Have Similar Claims To Counts One and Four. Now that the judge has ruled that these are plausible arguments, there will probably be a trend of plaintiffs amending their complaints to have similar — and stronger — arguments about the Medicaid provisions and the scope of the Commerce Clause.

No One Has Won/Lost… Yet. The ruling at this point is only instructing us that states may continue with their lawsuit. Although a dismissal would have been a better result for the federal government, it now has the opportunity to refine its argument in the Motion For Summary Judgment.

Motion For Summary Judgment Means That The Winner Takes All. A Motion For Summary Judgment is a pre-trial tactic that is employed frequently. Both sides again have the opportunity, through evidence, pleadings, etc., to state why they should win. If the states win, then the PPACA will be deemed unconstitutional. If the federal government wins, then the lawsuit will be dismissed. If neither wins, then the case will proceed to an actual trial (opening/closing arguments, discovery, etc.).

The Judge’s Ruling Is Not Binding Precedent For Other Courts. Although other courts that have lawsuits before them may consider the judge’s opinion in shaping their future decisions, they are not bound by his ruling because of two primary reasons: (1) The United States District Court is the lowest court in the federal system and therefore doesn’t make precedent and (2) Circuits in other areas of the country (i.e. other states) are not bound by authority in states or circuits other than their own.

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