FRIDAY, DECEMBER 17, 2010
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Politics & The Nation A11
Florida judge considers 20-state challenge of health-care law 6
BY N.C. AIZENMAN
pensacola, fla. — Three days after a federal judge granted Virginia’s request to void a key provision of the U.S. health-care overhaul law, a federal judge in this coastal city signaled that he is likely to follow suit in a case brought by Florida and 19 other states. Judge Roger Vinson of the
U.S.District Court for theNorth- ern District of Florida never explicitly stated how — or even when — he will rule, other than to say that it will be “as quickly as possible.” But his questioning Thursday gave further ammuni- tion to political opponents of the law and foreshadowed legal ar- guments likely to embroil courts across the country. During a nearly three-hour hearing on the merits of the
on
washingtonpost.com Testing the law
For a list of cases, go to
washingtonpost.com/health
case, Vinson frequently ap- peared to side with the states on the same question at the heart of the Virginia suit: Whether the law’s requirement that virtually all Americans obtain health in-
“The uninsured . . . impose those costs on the rest of us.”
—Ian Heath Gershengorn, deputy assistant attorney general, representing the administration
surance or pay a fine exceeds Congress’s constitutional au- thority. By contrast, Vinson expressed
skepticism over a second part of the law challenged in the multi-
state suit — that the statute violates state sovereignty by sub- stantially expanding Medicaid, the health insurance program for the poor that is jointly paid for by the federal government
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and states. The case, originally filed by
Florida Attorney General Bill McCullomandmany of the other states minutes after President Obama signed the controversial law in March, is one of two dozen constitutional challenges moving through federal courts. Most experts think that the law’s fate will ultimately be decided by the Supreme Court. Still, if Vinson rules in the
states’ favor, it would even the scorecard thus far: Two federal district court judges have up- held the law, and the judge in Virginia was the first to invali- date part of it. Vinson, a Republican appoin-
tee, rejected all but one of the Obama administration’s consti- tutional justifications for the insurance requirement in an October ruling. Thursday’s hear- ingwas limited to the remaining question of whether Congress’s constitutional authority to regu- late activities affecting inter- state commerce and enact laws “necessary and proper” for car- rying out that power applies. The states—joined in the suit
by two individuals and the Na- tional Federation of Indepen- dent Business, which represents small companies — claimed that a refusal to buy health insurance is not an economic activity, and thus lies outside the Constitu- tion’s commerce clause. The administration countered
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that this claimof inactivity is an illusion. Because virtually every- one will need health care at some point, deciding whether to obtain insurance amounts to making an economic decision about how to pay for care and has a substantial aggregate ef- fect on the health insurance market that Congress has the constitutional power to regu- late. During Thursday’s hearing,
Vinson repeatedly pushed back on this point. “In the broadest sense every
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decision we make is economic. The decision to marry. The deci- sion to keep a job or not has an economic effect,” he said. “If [the federal government] decided ev- erybody needs to eat broccoli because broccoli makes us healthy, they couldmandate that everybody has to eat broccoli each week?” Vinson also questioned the
notion that a person who choos- es not to buy insurance will necessarily be unable to pay for his or her health care. He him- self was uninsured, Vinson said, when one of his children was born, and he paid the entire bill. “I think it worked out to be
$100 a pound,” he said. “Not everyone who is unin-
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sured fails to pay,” conceded Deputy Assistant Attorney Gen- eral Ian Heath Gershengorn, representing the administra- tion. “But what Congress found is that, as a class, the uninsured consume care they cannot meet the costs for, and they impose those costs on the rest of us.” Vinson appeared uncon-
vinced, remarking soon after that, “itwould be a great leap for the Supreme Court to say that a decision to buy or not to buy is an activity. Thatwould be a giant expansion of the commerce clause.” On the case’s second issue, the
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constitutionality of expanding Medicaid, the judge sounded less sympathetic to the plain- tiffs. The law says that, starting in 2014, Americans with in- comes up to 133 percent of the poverty level will qualify for the program, a higher eligibility lev- el than most states use now. For the first few years, federal mon- ey will cover all of that expan- sion, but eventually states will have to pay 10 percent of the cost. Lawyers for the states and the
administration sparred over whether this would impose a crushing burden on state bud- gets. But as a legal matter, Vinson primarily focused on the states’ argument that though Medicaid is a voluntary program the downside of pulling out is so large that the states can’t afford to do so. Therefore expanding the program’s costs to them amounts to a violation of state sovereignty. Noting that officials in Texas
have considered pulling out of Medicaid, Vinson pressed Blaine H.Winship, an assistant Florida attorney general representing the states on whether they really are bound to participate. “Isn’t it still voluntary?” the
judge asked several times. In addition to Florida, the
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states party to the suit are South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Wash- ington, Idaho, South Dakota, Indiana, North Dakota, Missis- sippi, Arizona, Nevada, Georgia and Alaska.
aizenmann@washpost.com
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