On January 31, 2011 Federal District Judge Robert Vinson ruled that the individual mandate and indeed the entirety of the PPACA was unconstitutional. The ruling came in State of Florida v. U.S. Department of Health and Human Services, a legal challenge to PPACA brought by governors and attorneys general in 26 states. I have not had a chance to review in detail the 78-page opinion, but understand the ruling to be based on two main points – first, that the federal government cannot regulate inactivity through the Commerce Clause, and refusing to buy health insurance is inactivity, and second that the individual mandate is so thoroughly interwoven into the PPACA as a whole that the court could not “sever” that provision and rule only as to its constitutionality. Thus, although two prior federal district court, have upheld the constitutionality of the individual mandate, and one court found the mandate to be unconstitutional only last month, this is the first time that a federal court has ruled the entirety of PPACA to violate the Constitution.

The opinion contained one pro-PPACA nugget, however: Judge Vinson found that the PPACA’s requirement that states pay for a fractional share of expanding Medicare access does not violate the state sovereignty clause of the Constitution. Note that this conclusion is not inconsistent with the court’s position on severability, namely that the court was in no position to go through PPACA’s over 2,000 pages and determine which provisions could, and which could not, function independently from the individual mandate.

The Justice Department will appeal the ruling to the 11th Circuit; appeals of the prior 3 rulings are now pending in the 4th and 6th Circuits and more challenges are moving up at the federal trial court level, with the entire matter eventually heading to the Supreme Court in a process that could take 2 or more years. The individual mandate under challenge is not slated to go into effect until 2014.

To review the status of these cases and read briefs, rulings, and trenchant commentary, visit the ACA Litigation Blog and the Constitutional Law Prof Blog. These are wonderful resources on which I rely heavily when addressing litigation challenging the PPACA.

What does the most recent ruling mean for the forward progress of PPACA? Well, the court did not enjoin enforcement of the PPACA, and the ruling soon will be under appeal, so really nothing practical has changed for employers, insurers, and health plan participants. The cloud of uncertainty over PPACA just got a bit murkier, is all.

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