Today, led by Chief Justice John Roberts, the Supreme Court upheld the constitutionality of the Affordable Care Act in almost all respects. While upholding the controversial individual mandate to purchase health insurance, the Court did alter one important aspect of the law, however, in that it limited the government’s ability to withhold all Medicaid funds from a state contingent on the states’ acceptance of the significant Medicaid expansion called for under the Act. Under the Court’s ruling, a state must be allowed to opt out of the Medicaid expansion without threatening the state’s current Medicaid coverage and federal funding. The text of the decision can be found here.
On January 31, 2011, federal Judge Roger Vinson of the Northern District of Florida issued his widely anticipated ruling in the litigation brought by the attorneys general or governors of 26 states, along with other plaintiffs, challenging the 2010 health care reform legislation. Judge Vinson held unconstitutional the individual mandate provision. That provision, section 1501 of the Patient Protection and Affordable Care Act, requires everyone (with limited exceptions) to purchase federally approved health insurance, or pay a monetary penalty, beginning in 2014.
Judge Vinson’s ruling brings to two the number of district courts that have held the individual mandate unconstitutional. (Two other district courts have held the law constitutional). Unlike Judge Henry E. Hudson of the U.S. District Court for the Eastern District of Virginia, however, whose decision invalidating the individual mandate was issued on December 13, 2010, Judge Vinson found that the individual mandate could not be severed from the Act’s remaining provisions and, thus, declared the entire health care reform law unconstitutional. Judge Vinson reasoned that there are “simply too many moving parts in the Act and too many provisions dependent (directly and indirectly) on the individual mandate ... for me to try and dissect out the proper from the improper, and the able-to-stand-alone from the unable-to-stand-alone.”1 To attempt such a task would be “tantamount to rewriting a statute in an attempt to salvage it;”2 better to leave to “the watchmaker” the task of redesigning and reconstructing the “defectively designed watch.”3 Thus, although Judge Vinson upheld the Act’s expansions of the Medicaid program against constitutional challenge by the states, in the end his opinion holds that those provisions must fall—along with the entire Act—because, in the court’s view, they are not severable from the individual mandate.
As has been widely reported, on December 13, 2010, federal Judge Henry E. Hudson of the U.S. District Court for the Eastern District of Virginia ruled in favor of the motion for summary judgment filed by Virginia’s Attorney General, Kenneth Cuccinelli, and invalidated the so-called “individual mandate” in the health care reform legislation. There is no doubt that this case, which struck down one of the central provisions of the legislation, will make its way through the United States Court of Appeals for the Fourth Circuit and end up before the Supreme Court. In his 42-page decision, Judge Hudson ruled as unconstitutional PPACA Section 1501, which requires that starting in 2014 virtually every American must have a minimum level of health insurance coverage or be subject to a tax penalty. Although the court found that this provision exceeded Congress’s powers under the commerce and general welfare clauses of the U.S. Constitution, as a remedy, the court determined that it was appropriate to sever that section from the rest of the health care reform legislation instead of invalidating the entire health reform law. For additional analysis of this decision, please see the article on our sister-site, SCOTUSblog.”