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Court Fight Over Health-Care Reform Shifts to Florida

By Karen Pallarito
HealthDay Reporter

THURSDAY, Dec. 16 (HealthDay News) -- A federal judge in Florida will start hearing arguments Thursday in the latest legal challenge to the constitutionality of a key provision of the nation's new health-care reform law -- that nearly all Americans must carry health insurance or face a financial penalty.

On Monday, a federal judge in Virginia sided with that state's attorney general, who contended that the insurance mandate violated the Constitution, making it the first successful challenge to the legislation.

The dispute over the constitutionality of the insurance mandate is similar to the arguments in about two dozen health-care reform lawsuits that have been filed across the country. Besides the Virginia case, two federal judges have upheld the law and 12 other cases have been dismissed on technicalities, according to

What makes the Florida case different is that the lawsuit has been filed on behalf of 20 states. It's also the first court challenge to the new law's requirement that Medicaid be expanded to cover Americans with incomes at or below 133 percent of the federal poverty level (about $14,000 in 2010 for someone living alone). That Medicaid expansion has unleashed a series of protests from some states that contend the expansion will overwhelm their already-overburdened budgets, ABC News reported.

The federal government is supposed to pick up much of the Medicaid tab, paying $443.5 billion -- or 95.4 percent of the total cost -- between 2014 and 2019, according to an analysis by the non-partisan Kaiser Family Foundation, the news network reported.

The Florida lawsuit has been filed by attorneys general and governors in 20 states -- all but one represented by Republicans -- as well as the National Federation of Independent Business, an advocacy group for small businesses, reported.

The federal government contends that Congress was within its legal rights when it passed President Barack Obama's signature legislative goal in March.

But the battle over the law, which has pitted Obama and fellow Democrats against Republicans, will continue to be fought in the federal court system until it finally reaches the U.S. Supreme Court, perhaps as early as next year, experts predict.

During an interview with a Tampa, Fla., TV station on Monday, after the Virginia judge's decision, Obama said: "Keep in mind this is one ruling by one federal district court. We've already had two federal district courts that have ruled that this is definitely constitutional."

"You've got one judge who disagreed," he said. "That's the nature of these things."

Earlier Monday, the federal judge sitting in Richmond, Va., ruled that the health-care legislation, signed into law by Obama in March, was unconstitutional, saying the federal government has no authority to require citizens to buy health insurance.

The ruling was made by U.S. District Judge Henry E. Hudson, a Republican appointed by President George W. Bush who had seemed sympathetic to the state of Virginia's case when oral arguments were heard in October, the Associated Press reported.

But as the Washington Post noted, Hudson did not take two additional steps that Virginia had requested. First, he ruled that the unconstitutionality of the insurance-requirement mandate did not affect the rest of the law. And he did not grant an injunction that would have blocked the federal government's efforts to implement the law.

White House officials had said last week that a negative ruling would not affect the law's implementation because its major provisions don't take effect until 2014.

Two weeks ago, a federal judge in nearby Lynchburg, Va., upheld the constitutionality of the health insurance requirement, The New York Times reported. "Far from 'inactivity,'" said Judge Norman K. Moon, who was appointed by President Bill Clinton, "by choosing to forgo insurance, plaintiffs are making an economic decision to try to pay for health-care services later, out of pocket, rather than now, through the purchase of insurance." A second federal judge appointed by Clinton, a Democrat, has upheld the law as well, the Times said.

In the case decided Monday, Virginia Attorney General Kenneth Cuccinelli, a Republican, had filed a lawsuit in defense of a new Virginia law barring the federal government from requiring state residents to buy health insurance. He argued that it was unconstitutional for the federal law to force citizens to buy health insurance and to assess a fine if they didn't.

The U.S. Justice Department said the insurance mandate falls within the scope of the federal government's authority under the Commerce Clause. But Cuccinelli said deciding not to buy insurance was an economic matter outside the government's domain.

In his decision, Hudson agreed. "An individual's personal decision to purchase -- or decline to purchase -- health insurance from a private provider is beyond the historical reach of the Commerce Clause," the judge said.

Jack M. Balkin, a professor of constitutional law at Yale University who supports the constitutionality of the health-reform package, told the Times that "there are judges of different ideological views throughout the federal judiciary."

Hudson seemed to reflect that reality when he wrote in his opinion that "the final word will undoubtedly reside with a higher court," the Times reported.

By 2019, the law, unless changed, will expand health insurance access to 94 percent of non-elderly Americans.

More information

To learn more about the impact of the Affordable Care Act, visit this U.S. Department of Health and Human Services Web site.

SOURCES: Devon Herrick, Ph.D., senior fellow, National Center for Policy Analysis, Dallas; Dec. 13, 2010, news release, Consumers Union, Washington, D.C.;; ABC News; Associated Press; The Washington Post; The New York Times

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