Florida Judge Rules Health Care Law Unconstitutional

By Lloyd the Idiot



Report here.  Full opinion here

I haven’t read the full opinion yet, but I certainly don’t expect this will be the  outcome after all appeals are exhausted (as much as I would like it to be). 


Relevant portion of opinion below the fold.

From the decision:

“The existing problems in our national health care system are recognized by everyone in this case. There is widespread sentiment for positive improvements that will reduce costs, improve the quality of care, and expand availability in a way that the nation can afford. This is obviously a very difficult task. Regardless of how laudable its attempts may have been to accomplish these goals in passing the Act, Congress must operate within the bounds established by the Constitution. Again, this case is not about whether the Act is wise or unwise legislation. It is about the Constitutional role of the federal government.

For the reasons stated, I must reluctantly conclude that Congress exceeded the bounds of its authority in passing the Act with the individual mandate. That is not to say, of course, that Congress is without power to address the problems and inequities in our health care system. The health care market is more than one sixth of the national economy, and without doubt Congress has the power to reform and regulate this market. That has not been disputed in this case. The principal dispute has been about how Congress chose to exercise that power here.

Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void. This has been a difficult decision to reach, and I am aware that it will have indeterminable implications. At a time when there is virtually unanimous agreement that health care reform is needed in this country, it is hard to invalidate and strike down a statute titled “The Patient Protection and Affordable Care Act.” … In closing, I will simply observe, once again, that my conclusion in this case is based on an application of the Commerce Clause law as it exists pursuant to the Supreme Court’s current interpretation and definition. Only the Supreme Court (or a Constitutional amendment) can expand that.

For all the reasons stated above and pursuant to Rule 56 of the Federal Rules of Civil Procedure, the plaintiffs’ motion for summary judgment (doc. 80) is hereby GRANTED as to its request for declaratory relief on Count I of the Second Amended Complaint, and DENIED as to its request for injunctive relief; and the defendants’ motion for summary judgment (doc. 82) is hereby GRANTED on Count IV of the Second Amended Complaint. The respective cross-motions are each DENIED. In accordance with Rule 57 of the Federal Rules of Civil Procedure and Title 28, United States Code, Section 2201(a), a Declaratory Judgment shall be entered separately, declaring “The Patient Protection and Affordable Care Act” unconstitutional.”


  • squiddy says:

    Obviously, this isn’t settled law yet, with a long row to hoe before we reach the end of this.

    Meanwhile, is it not possible to introduce legislation that, in isolation, reinforces the good, without replicating all the troublesome language? I mean, Republicans say that there are provisions that “everyone can agree on” – for example, pre-existing coverage – is it feasible to put those in-place now, so that if when this law is overturned (and it will seem to be overturned on a frequent basis), there are provisions already in-place to maintain the “good bits”?

    For example, can stand-alone legislation be introduced and passed that allows for children up to the age of 26 to be put on their parents coverage? Deal with pre-existing conditions?

    ’cause I can guarantee you, the lineup over at MSNBC will be trotting out all of the “beneficiaries” of the new provisions, who are now “victims”, soon to be dead or homeless, now that those mean, nasty Republicans have somehow found yet-another insane judge to overturn the law …

    While we’re at it, how about Tort Reform?

  • pprados says:

    The only actual item that has been declared unconstitutional -by itself- in either Florida or Virginia is the individual mandate.

    If Democrats had the political will and power, the remainder of the law could be reenacted immediately. Democrats will probably never accept a dramatically watered down version that the House would support, so the parts “everyone can agree on” would have to be tacked onto some other bill.

  • john millhiser says:

    pp- two chances of this Congress re-enacting the balance of the bill sans the mandate. SLIM AND NONE and Slim is already headed south for the winter.

  • edmundburkenator says:

    Didn’t Obama mention tort reform in the SOTU?

  • Linda B says:

    Squiddy, I heard a good explanation of this on the radio tonight. The guy (sorry, he was someone I’d never heard of) said, “This isn’t a government takeover of health care, it’s an insurance company takeover of health care.” He explained that the insurance companies would never have agreed to eliminate their pre-existing conditions clauses without the individual mandate portion in effect. They couldn’t afford to … they need that massive pool to make it work.

    It helped put the issue into perspective for me, though I’m still squarely on the side of repealing or defeating the mandate.

  • Tom Seeman says:

    pprados – if you’re really a lawyer, then you should know that Judge Hudson ruled the entire health care bill to be unconstitutional, not just the individual mandate.


  • Tom Seeman says:

    Further, Obama Care as a whole falls without the individual mandate. You can’t just enact parts; they all depend on the individual mandate. This is another reason why the ruling is so significant.


  • ppradoslaw says:

    I tend to agree. But, perhaps a coalition left/middle might successfully attach mandated coverage for preexisting conditions to an appropriations bill for example.

    My point was the remainder of the bill, if unattached to an individual mandate, would not have been struck down by either Judge Hudson or Judge Vinson.
    I agree with National Review’s analysis.
    Judge Vinson in Florida ruled the whole thing unconstitutional because of the individual mandate.
    Judge Hudson in Virginia only ruled the individual mandate unconstitutional.
    From Judge Hudson’s opinion: http://www.scribd.com/doc/45218191/US-District-Court-Ruling

    “On careful review, this Court must conclude that section 1501of the [PPACA] – specifically the Minimum Essential Coverage Provision – exceeds the constitutional boundaries of congressional power.” P. 38

    “ . . . the Court will sever only Section 1501 and directly-dependent provisions that make specific reference to Section 1501.” P. 40

    My analysis of the two opinions can be found here:

    Yes I am a lawyer, and yes we appear to be on the same side.

  • Barbara Munsey says:

    Tom or someone, please correct me if I’m wrong, but it’s a bit of a hairsplit:

    Because there is no ability to sever one clause from the others, the fact that he found the one unconstitutional throws out the whole shebang.

    That’s how I understand it, but I may be wrong.

  • Ryan Cool says:

    Tort reform is needed, but doesn’t even begin to solve the larger healthcare crisis. Some call this decision judicial activism, and perhaps it toes the line. I am certainly not a fan of Obamacare in its entirety, but that’s where he and the Dems failed miserably. If they would have went back to public policy 101 class they would look at Chapter 1 and see that something this large needs to be implemented incrementally. Parts such as the pre-existing condition provision should stay, but where are the real solutions? Neither side has fixed anything and both have had their chances.

  • john millhiser says:

    PPlaw- Left-middle coalition left with Slim.

  • Ben Belrose says:

    Pre-existing conditons can not logically be supported without universal coverage. It would be akin as buying auto insurance after you had an accident. Presently, HIPPA prevents pre-existing conditions from being imposed whenever you change insurance companies. It also limits pre-existing conditions restrictions to a one year period after you start the insurance. A comporomise that might work is to disallow pre-existing conditions during an open season period similar to what goes on now with Medicare supplemental insurance and between various plans at large commercial firms. Just imposing pre-existing conditions on private insurance companies will lead to bankruptsy of the companies. This will lead directly to the single payer system that libs all want. While it sounds nice, it is not workable.

    Of course the press will alway quote the huge profits of the big insurance companies. But actually if you check it out, the profit margin is in the low single digits for most health insurance companies. Of course since health care is a huge amount of the economy, I have heard 1/6th, the base is extremely high so the profits seem excessive. But every time the country or state mandates benefits like extending coverage of kids to age 26, there is a cost that has to be paid for by someone. It isn’t free. Consider how many children out-of-wedlock would be covered by extending the kids to age 26. Hence the cost to everyone is increased. The same for extending the coverage to a $2M maximum and eventually to an unlimited maximum. How about the requirement to make health care companies responsible for the educational expenses of Downs kids. Without applying any judgement as to whether this is a good thing or a bad thing, if it is implemented, everybody will see their rates go up to cover the expense. I expect the insurance companies don’t really care what is mandated so long as people are willing to pay for it all. But we should all be cautious about mandated certain items in any policy shold because everytime the rates go up more people will go without health insurance because they will not be able to afford it.

  • BlackOut says:

    Ben, exclusions for pre-existing conditions should be disallowed period. I don’t care what it costs, me, the government or the insurance companies.

    Folks with pre-existing conditions are amongst those with the greatest need. Eliminating the burden of getting insurance is the least a compassionate society can do.

  • Ryan Cool says:


    Regarding your statement that: “Pre-existing conditons can not logically be supported without universal coverage”, that just isn’t the case at all. However, it is an argument that is heavily used by the GOP, and the insurance lobby.

    HIPAA does not prevent pre-existing conditions from being imposed whenever you change insurance companies. HIPAA does limit pre-existing condition exclusions, to an extent. The list of pre-existing conditions that may be recognized is not eliminated as a result of HIPAA.

    However, the law does not define the benefits an insurance company is required to offer to the individual. As a cancer survivor and a health policy wonk, HIPAA certainly does not solve this issue.

  • Ben Belrose says:

    Will anyone sell me a retroactive auto policy the day after I have an accident that is my fault? If there are no pre-existing condition clauses, a person would be foolish to buy insurance before they had a serious medical condition. Of course, the cost of medical insurance would make it so expensive that very few would be able to afford it. There is an economic reality that exists here and no manner of good intentions can undo this reality. The average person cannot get more in benefits than the average person pays in premiums. To do so is called bankruptcy. So if you pass a law that says the insurance company cannot have pre-existing conditions and cannot enforce universal coverage then the price will necessarily skyrocket (to paraphrase Obama’s statement on energy). For example, I had a triple by-pass surgery so if I had waited until it was diagnosed and then applied for insurance they would have to set my rate at about $100K per year in order to break even. But since I was healthy and they normally spent less on me than my premium, like most people, there are funds available when someone who has been paying into the pool for decades on end has a catastrophic medical emergency. Now if you take all the healthy people out of the mix and only have the people who need lots of care, no one would be able to afford the insurance. I’m sorry Blackout but that is how the system works and your good intentions cannot change that.

    Ryan, HIPPA is far from perfect but it was designed to allow people to change jobs without having to undergo a year with little or no coverage. So if you change jobs but have no period where you do not have insurance then it prohibits the imposition of pre-existing conditions. I tried to hire a guy one time from a competitive company. It was a really good fit and he wanted to come. It came down to him turning the new job down because one of his kids was diabetic and it would not have been covered for a year. HIPPA would have prevented this dilemma.

  • BlackOut says:

    Ben, you have a misunderstanding of HIPAA as it is related to pre-existing conditions. HIPAA would not and will not help a person over the age of 18 with a pre-existing condition of diabetes. Your example uses a child which is an exception. It isn’t the same for people over 18.

    Under HIPAA, a plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan. Specifically, the law says that a preexisting condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in the plan. As an example, the insurance applicant may have had diabetes for many years before coming to the current job. If you did not have medical advice, diagnosis, care, or treatment – recommended or received – in the 6 months before you enrolled in the plan, then the prior condition cannot be subject to a preexisting condition exclusion. If you did receive medical advice, diagnosis, care, or treatment within the past 6 months, then the plan may impose a preexisting condition exclusion for that condition (diabetes).

    I think it’s unrealistic to think a person with diabetes can abstain from medical treatment or care for six months just so that person can change jobs. HIPAA has no teeth for pre-existing conditions.

    In your example of by-pass surgery. If you had the surgery within six months of changing jobs you could be excluded from a health plan due to the pre-existing condition. If you went to your doctor for a check-up post surgery within six months you would not be protected by HIPAA for a pre-existing condition, and could be denied insurance. If as a result of your by-pass you were required to take medicine for the rest of your life you would not be protected by HIPAA for a pre-existing condition and could be denied insurance. You’re right about one thing HIPAA is far from perfect.

  • BlackOut says:

    There must be millions of ordinary people that are effected by pre-existing conditions and as a result can’t get health insurance.

    As stated above there is no protection for these folks.

    The self employed carpenter who has persistent ringing in the ears is denied health insurance because he has a pre-existing condition.

    The school teacher who comes down with a debilitating illness and is unable to keep working is unable to get affordable health insurance because of a pre-existing condition.

    There are many additional scenarios. We disagree but I feel more compassionate for these individuals. If everyone’s premiums go up to help out these people then so be it. Let everyone share the burden. After all one never knows when the unimagninable becomes your personal nightmare.

  • Ryan Cool says:

    now that we agree the HIPAA isn’t perfect, and certainly doesn’t eliminate the pre-existing condition issue, let me just say that the COBRA option to maintain health coverage is also cost prohibitive.

    Now for the bigger issue that both parties avoid like the plague: entitlements. Social Security can be fixed, but Medicare is simply not sustainable. So how are Conservatives going to solve this issue?

  • G.Stone says:


    Have you ever tried to get coverage for your pre-existing condition ?

  • M. Malaney says:

    So, I’m on COBRA currently, which expires on 2/13/11 (apparently the powers-that-be don’t realize that insurances won’t insure you in the middle of the month), so if COBRA is not extended again, I will have to go without insurance for two weeks and pray that nothing happens in that period of time. Now, I applied for another insurance but was told that there was a one year stipulation on pre-existing conditions. When I went to my doctor, he said he was of the understanding that this was against the law – that insurance companies could not impose pre-existing conditions if you are simply switching insurances. Is he correct?

  • Ben Belrose says:

    M. Malaney,
    My understanding is that as long as you have insurance and there is no gap in coverage, they cannot impose existing conditions when you switch insurance companies.

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