The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Federal Judge Declares PPACA Unconstitutional

Posted by Alan on January 31, 2011

Federal District Court Judge Roger Vinson declared the Patient Protection and Affordable Care Act unconstitutional. The ruling in a suit brought by governors and attorneys general from 26 states is the most sweeping legal decision against President Barack Obama’s health care reform package. 

Specifically, Judge Vinson decision focused on the legislation’s requirement that all Americans obtain health care coverage (the individual mandate). He found the individual mandate violated the Commerce Clause (while in the same decision dismissing plaintiff’s claim the PPACA was unconstitutional because of the changes it makes to the Medicaid program

All of this was expected. What was a bit of suprise is that Judge Vinson went further stating:  “Because the individual mandate is unconstitutional and not severable, the entire act must be declared void.”  Compare this to the December decision by U.S. District Judge Henry Hudson who ruled in a suit brought by the state of Virginia that the individual mandate was unconstitutional. Judge Hudson, however, determined that those provisions of the health care reform law that did not depend on the individual mandate “are legal and can proceed.”

Reuters describes Judge Vinson as struggling with the decision to invalidate the entire law as he recognized the decision “will have indeterminable implications” – which is legalese for “this shakes things up a bit, doesn’t it?” In the end, however, as reported by the New York Times, he determined that the individual mandate “exceeds the regulatory powers granted to Congress under the Commerce Clause of the Constitution. Judge Vinson wrote that the provision could not be rescued by an associated clause in Article I that gives Congress broad authority to make laws ‘necessary and proper’ to carrying out its designated responsibilities.”

Significantly, Judge Vinson decided not to stop implementation of the PPACA from moving forward pending appeals. Nonetheless, one of the the lawyers for the states, David Rivkin, Jr., was quoted as declaring that “With regard to all parties, the statue is dead. The statute is as if it never was.”

Well, not really. If Judge Vinson had suspended or enjoined the law Mr. Rivkin would have something more than enthusiasm to stand upon. But by allowing work on implementing reform to move forward, this decision becomes part of a mix of several cases. With District Judges ruling to strike down part (and now all) of the Patient Protection and Affordable Care Act and others upholding the health care reform law the next step is for Appellate Courts to hear appeals of these decisions.

Eventually the question of whether the PPACA is constitutional or not will be determined by the U.S. Supreme Court. Which will be fascinating to watch. While Justices prize their independence, the fact is that they all have a point of view based on a mix of their understanding of the law and constitution, their personal experience, and their political ideologies – not in equal measure. While there may be surprises, what this could mean is that the fate of President Obama’s signature legislative accomplishment is in the hands of Justice Anthony Kennedy. The reason is that four of the Justices are expected to be skeptical of expanding the Commerce Clause while four are likely to be more comfortable with the idea. Justice Kennedy is viewed as a moderate and the swing vote on the Court as currently comprised.

In the meantime implementation of the PPACA by regulators, carriers and others will continue apace – as will legislative attempts in Congress and state legislatures to modify (or repeal) the law. All of which means that Judge Vinson’s declaration that the PPACA is unconstitutional is an interesting chapter in the history of reforming health care and health care coverage in America, but it’s only a chapter in a very long book.

Here’s a link to the text of Judge Vinson’s ruling striking down the health care reform law as unconstitutional.

For those who prefer to listen to their legal analysis, NPR offers a clear presentation of Judge Vinson’s decision.


7 Responses to “Federal Judge Declares PPACA Unconstitutional”

  1. David Mair said

    This is a remarkable ruling as it focuses on an issue the Supreme Court has yet to address, whether absence of commercial activity is itself commercial activity. Reading Jefferson, Madison and Adams suggests commerce must be active, essentially transactional. Looking at Judge Vinson’s recitation of the history, including rulings by some of America’s most revered jurists, makes clear that this Supreme Court must deal with the issue of whether to interpret the Constitution based on its foundational principles or today’s political environment. I, for one, hope even the more liberal members of the Court are not swayed away from protecting the Constituton itself.

    It’s worth noting that even advisors to the White House and the Congressional leadership warned them this was quite likely a bridge to far.

  2. B DePalma said

    Judge Vinson has made gross errors in his decision and will be reversed at SCOTUS. Our founding fathers- the very ones who signed the constitution passed mandatory insurance and government provided health care in the 5th congress. Look here for some background:
    And here for more links:

  3. Chris Taus said

    The fact that trial judges are political appointees gives the decision even less meaning, especially when the judge rules exactly how you would expect. Barring a death or retirement of one of the conservative justices on the Supreme Court, the healthcare mandate will come down to Anthony Kennedy, and its fate is no more decided today than it was yesterday.

  4. JimK said

    It’s interesting to note that the PPACA was passed because proponents of the plan in an attempt to draw some Republican support specifically avoided implementing a tax to pay for portions of the Act and this proved to be their Achilles Heel. Granted the Democrats did include a tax but opponents of the Act determined that this was not a true tax but a penalty and therefore fell outside the scope of the Federal Government to levy taxes.
    While their is ample caselaw to support implementing penalties in lieu of taxes as a means of enforcing a specific Congressional intent Judge Vinson chose in his recent decision chose not to address this issue. Judge Vinson stated that he had previously addressed the fact that the penalty was not a legitimate tax.
    Judge Vinson focused on the Commerce Clause and while he made some amusing anecdotes his ruling on this issue was consistent with opponents of the Bill who stated that the government had no authority to mandate an individual purchase a particular product and stressed the Supreme Court decisions limiting the authority of the Commerce Clause. In defense of Judge Vinson and his ideology he did not seem particularly impressed with the Supreme Court Decision banning the use of marjuana for medicinal purposes. His writings indicate he felt that this decision was an overreach by the Supreme Court.
    As to striking down the entire law; I believe Judge Vinson was on solid legal ground on this point. The final version of the PPACA does not include a severability clause, whereas prior versions did include this provision. Judge Vinson determined that since a severability clause was contemplated and then dropped Congress intended that the law should be considered in its entirety.
    However, in my opinion, the weak link in Judge Vinson’s reasoning focuses on invalidating the Necessary and Proper Clause of the Constitution as redundant to the enumerated powers. Towards this end Judge Vinson takes a Hamilton quote from the Federalist papers out of context, implying that Hamilton perceived the Necessary and Proper Clause as redundant. A reading of the entire section cited by Judge Vinson demonstrates that Hamilton did not hold this belief, and in fact, Hamilton believed that without the Necessary and Proper Clause the States would eventually sap the foundations of the Union( Federalist #33). Note: Judge Vinson actually wrote that the Commerce Clause and the Necessary and Proper Clause were not mutually exclusive.
    In the end the decision will be based on which side of the bed Justice Kennedy wakes up on; if he wakes on the side of the bed where he ruled that a State can take Private Property for the benefit of another Private entity (Kelo v New London) then the PPACA will stand, if not it will fall.
    Right now the Democrats have time on their side as certain provisions take effect and if they are popular with the beneficiaries of these provisions the Republicans may find it harder to demonize the PPACA.

  5. Jim Thornton said

    A bit depressing.

    Changing healthcare is sort of like tearing down the Berlin Wall. Lots of hopes raised for many of us. Some fears, too, I suppose, from others.

    And now Russia is a dysfunctional mess, albeit a diminished dysfunctional mess.

    My brother had an interesting metaphor for the healthcare situation in sinking-ship America: there are those who have comfortable seats on the life raft, and those treading water in the cold sea. When the latter do their best to hold on to the side of the raft, perhaps even have the temerity to try hoisting themselves up and in, the former stomp on their fingers and do their best to pry them back into the frozen brine!

    The justification of these goodly folks on the life boat? If we let those wretches in, it will sink the boat and we’ll all be drowned. In the non metaphorical world, the pitiless ocean are the national deficits–something that Old Dick Cheney so famously said, just a few years back, “don’t matter.” How times have changed now that we need moral cover for finger stomping!

    In PA, my home state, the Legislature has just proposed that all our elected officials need to start paying part of their state funded health insurance premiums. The proposal: they must contribute 1 percent of their salaries!

    1 percent!

    These are the same fellows who are risking hypertension and they take turns jumping up and down on my already broken fingers!

    Those advocating for “repeal and replace” measures–i.e., returning things to the former horrific status quo–should be ashamed of themselves.

    There’s no going back now that the Berlin Wall has been broken. But the way forward has lost its promise, too. Things are looking worse all the time.

  6. Rick Kolstad said

    The “idealist” in me says, this may send congress back to the drawing board to determine how to implement the idea of “coverage for all” against the very real challenge of avoiding the dread adverse selection-an annual open enrollment comes to mind-and a few other potential pitfalls in the current law. When I look at this through my cynical and skeptical filter, I realize that ultimately we will spend a great deal more time and money as opponents and proponents of PPACA continue to hack away and repel said attacks, at various and sundry items within the law. At day’s end, I view the continual bickering and infighting as the greatest threat to all of our welfare; consider it a greater threat than diminished commissions.

  7. Andrea said

    So what now? In the meantime, insurance companies have to go forward based upon their best guess? Some are already pulling out of certain markets (Aetna, Colorado) Also, the damage to agent has already occurred, and won’t change anytime soon with all of this uncertainty.

    Seems the only thing accomplished by having the mandate considered unconstitutional is to make it easier for single-payor to slip in since you can’t have guaranteed issue without the mandate (and it seems like politicians know that, I think). Medicare for all, right? You think our taxes are high now?

    On the bright side, maybe there is an opportunity to sell Medicare supplements to everyone that can afford them when all of this goes down.

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