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Another Appeals Court Rejects Federal Health Care Law

Calling it an”unprecedented exercise of congressional power,” a federal appeals court Friday sided with Florida and 25 other states in rejecting a plan that would require almost all Americans to have health insurance in 2014.

The insurance requirement, known as the individual mandate, is a linchpin of the health-system overhaul that President Obama and congressional Democrats approved in 2010.

But a divided 11th U.S. Circuit Court of Appeals in Atlanta ruled that the mandate is unconstitutional, saying it is “unprecedented, lacks cognizable limits and imperils our federalist structure.”

“This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives,” Chief Judge Joel Dubina and Judge Frank M. Hull wrote in the 207-page majority opinion.

But Judge Stanley Marcus wrote a stinging dissent, siding with the Obama administration’s argument that the mandate is allowed under the constitution’s Commerce Clause.

“The parade of horribles said to follow ineluctably from upholding the individual mandate includes the federal government’s ability to compel us to purchase and consume broccoli, buy General Motors vehicles and exercise three times a week,” Marcus wrote. “However, acknowledging the constitutionality of the individual mandate portends no such impending doom.”

Former Florida Attorney General Bill McCollum spearheaded the challenge to the health overhaul, immediately filing suit last year in U.S. District Court in Pensacola after Obama signed the law.

The case, which was joined by other states, the National Federation of Independent Business and two individuals, has become perhaps the most closely watched challenge to the law, which Republicans derisively call “Obamacare.”

The U.S. Supreme Court is ultimately expected to decide the constitutionality of the overhaul. But Florida Republicans praised the appeals-court ruling Friday.

“It is critical that this case be expedited to the United States Supreme Court so that we can put this job-killing federal government mandate behind us and begin making the meaningful improvements our healthcare system needs without infringing on the liberties of Americans,” said Gov. Rick Scott, who has made opposition to the law one of his signature issues.

Florida CHAIN, a health-advocacy group that backs the overhaul, said the court decision was disappointing. But with the dispute headed to the Supreme Court, the group said Florida should move forward with the law, which is known as the “Affordable Care Act.”

“Implementation of the (law) is critical to the health and well-being of Floridians,” Florida CHAIN said in a statement.

In finding the individual mandate unconstitutional, the appeals court upheld part of a January ruling by Pensacola federal judge Roger Vinson. But the court overturned another part of Vinson’s ruling, which said the entire health-care law should be tossed out because the individual mandate could not be separated from other changes approved by Congress.

Also, the appeals court agreed with the Obama administration on the law’s massive expansion of the Medicaid program, which is part of a multi-pronged strategy to expand health coverage.

Florida and other states have fought the expansion, accusing Washington of “coercion.” They contend they would have to go along with the expansion or face the possibility of losing billions of dollars in federal funding for Medicaid.

The court, however, ruled the Medicaid portion of the law was not “unduly coercive,” noting that the federal government will pick up almost all of the initial costs after the expansion takes effect in 2014. Also, the court said that states in the past have faced the choice of complying with Medicaid changes or giving up funding.

“(The) Medicaid-participating states were warned from the beginning of the Medicaid program that Congress reserved the right to make changes to the program,” the judges wrote.

While the Medicaid issue is important to states, the individual mandate is the most legally — and politically — volatile issue in the fight about the Affordable Care Act. People who do not comply with the mandate would have to pay financial penalties.

The Obama administration argues that such a mandate is critical to dramatically reducing the number of uninsured people in the country.

It contends that the Commerce Clause allows such a mandate, at least in part because of “cost shifting” that occurs when uninsured people need health care and cannot pay for it. Such scenarios lead to other people paying higher insurance premiums or taxes to cover the costs.

Marcus, an appointee of former Democratic President Bill Clinton, pointed to the large number of people who lack health insurance and said their inability to pay for health care has a “profound effect” on commerce.

“There is a less of a chance that an individual will go through his entire life without ever consuming health-care services than there is that he will win the Irish Sweepstakes at the very moment he is struck by lightning,” Marcus wrote. “Nor are there more than a miniscule number of Americans who could afford to take on the financial risk of a personal medical catastrophe out of their own pockets.”

But Hull, a Clinton appointee, and Dubina, an appointee of Republican former President George H.W. Bush, said the Supreme Court has never interpreted the Commerce Clause to allow Congress to “dictate the financial decisions of Americans through an economic mandate.”

“In sum, the individual mandate is breathtaking in its expansive scope,” Hull and Dubina wrote jointly. “It regulates those who have not entered the health care market at all. It regulates those who have entered the health care market but have not entered the insurance market (and have no intention of doing so).”

It remained unclear Friday when the Supreme Court might take up the constitutionality of the health law. It also is unclear whether justices would consider the 11th Circuit decision or one of several other cases that have drawn mixed rulings from judges across the country.

But state Rep. Matt Hudson, a Naples Republican who is a critic of the federal law, said the rulings by the appeals court and Vinson are a sign that the individual mandate could be found unconstitutional.

“This is a very good indicator that what we have been saying all along is in fact correct,” said Hudson, the House’s chief health budget writer.

By Jim Saunders
The News Service of Florida