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The Constitutionality of Health Care Reform?

Posted on January 31, 2011 in Health Law News

Written by: Betner, Brian C.

This installment of Hall Render’s Health Law Broadcast series on health care reform is designed to provide you with the insight, analysis and practical suggestions with respect to the various reform initiatives that will affect your organization. 

On January 31, 2011, Senior U.S. District Judge Roger Vinson issued his much-anticipated order in favor of the State of Florida and 25 other states that challenge the Patient Protection and Affordable Care Act (“PPACA”) as unconstitutional.  The following excerpts fairly summarize Judge Vinson’s 78-page order, which will undoubtedly be debated by constitutional law scholars around the country:

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.

The Obama Administration had already indicated prior to release of this order that it would appeal Judge Vinson’s ruling.  His ruling, which does not have an immediate impact on implementation of PPACA, will join other cases pending in the 4th and 6th Circuits.  The Court of Appeals for the 4th Circuit has already scheduled hearings for May on conflicting federal court rulings in the Circuit regarding constitutionality of the individual mandate.  It seems inevitable that all questions regarding the constitutionality of PPACA will be presented to the U.S. Supreme Court.  Congress may also undertake a targeted response depending on the various repeal and defunding activities that are currently underway.  Even Judge Vinson seems to acknowledge the probability of a legislative response:

If Congress intends to implement health care reform — and there would appear to be widespread agreement across the political spectrum that reform is needed — it should do a comprehensive examination of the Act and make a legislative determination as to which of its hundreds of provisions and sections will work as intended without the individual mandate, and which will not.  It is Congress that should consider and decide these quintessentially legislative questions, and not the courts.

Here is Judge Vinson’s opinion in its entirety:

Hall Render will continue to watch this case and others as they develop across the country.  Should you have any questions, please contact

Please visit our Health Care Reform site at for current information and resources regarding health care reform issues and regulations.