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Florida Judge Strikes Down Entirety of Obamacare



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Federal District Court judge Roger Vinson has ruled that the entire Patient Protection and Affordable Care Act is unconstitutional. The ruling does not — as some hoped — halt the implementation of the law, but it is the widest invalidation of Obamacare to yet emerge from the courts.

The ruling is here. More as I — and far abler minds — read it.

UPDATE: Vinson’s opinion is a summary judgment, meaning there are no disputes on matters of fact between the states and individuals comprising the plaintiffs and the federal government. At issue are pure matters of law: the constitutionality of the individual mandate under the Commerce Clause, and of the unfunded Medicaid expansion under the Spending Clause, Ninth, and Tenth Amendments. Indeed, early in the decision Vinson signals he sees the case as one about federalism:

“I emphasized once before, but it bears repeating again: this case is not about whether the Act is wise or unwise legislation, or whether it will solve or exacerbate the myriad problems in our health care system. In fact, it is not really about our health care system at all. It is principally about our federalist system, and it raises very important issues regarding the Constitutional role of the federal government.”

On the Commerce Clause piece, the focus is on whether the individual mandate goes beyond Congress’ authority to regulate “those activities having a substantial relation to interstate commerce, i.e., those activities that substantially affect interstate commerce” (United States v. Lopez 1995). Vinson cites eminent conservative legal minds like Robert Bork and Randy Barnett en route to a determination that yes, it does.

In the key passage, from page 42, Vinson concludes that there is no legal basis for regulation of inactivity (pay attention for the (original) tea party shoutout!):

It would be a radical departure from existing case law to hold that Congress can regulate inactivity under the Commerce Clause. If it has the power to compel an otherwise passive individual into a commercial transaction with a third party merely by asserting — as was done in the Act — that compelling the actual transaction is itself “commercial and economic in nature, and substantially affects interstate commerce” [see Act § 1501(a)(1)], it is not hyperbolizing to suggest that Congress could do almost anything it wanted. It is difficult to imagine that a nation which began, at least in part, as the result of opposition to a British mandate giving the East India Company a monopoly and imposing a nominal tax on all tea sold in America would have set out to create a government with the power to force people to buy tea in the first place. If Congress can penalize a passive individual for failing to engage in commerce, the enumeration of powers in the Constitution would have been in vain for it would be “difficult to perceive any limitation on federal power” [Lopez, supra, 514 U.S. at 564], and we would have a Constitution in name only.

The news was different on the Medicaid expansion count. Here, Vinson cites South Dakota v. Dole (1987) as the controlling case. (And that’s Elizabeth Dole, then Secretary of Transportation; the case concerned the constitutionality of the feds withholding tax revenue from states for having drinking ages below 21.) :

Under Dole, there are four restrictions on Congress’ Constitutional spending power: (1) the spending must be for the general welfare; (2) the conditions must be stated clearly and unambiguously; (3) the conditions must bear a relationship to the purpose of the program; and 4) the conditions imposed may not require states “to engage in activities that would themselves be unconstitutional.” Supra, 483 U.S. at207-10. In addition, a spending condition cannot be “coercive.” This conceptional requirement is also from Dole, where the Supreme Court speculated (in dicta at the end of that opinion) that  “in some circumstances the financial inducement offered by Congress might be so coercive as to pass the point at which ‘pressure turns into compulsion.’” See id. at 211 (citation omitted). If that line is crossed, the Spending Clause is violated.

The states argued that the Medicaid expansion runs afoul of the coercion provision, facing them with an untenable Hobson’s Choice.

They must either (1) accept the Act’s transformed Medicaid program with its new costs and obligations, which they cannot afford, or (2) exit the program altogether and lose the federal matching funds that arenecessary and essential to provide health care coverage to their neediest citizens (along with other Medicaid-linked federal funds).

Crucially, Vinson did not find for the states here, ruling that the states’ participation in Medicaid is purely voluntary, and that their argument that the expansion of the program under the ACA will eventually break their budgets is based on highly disputable economic assumptions. But even in dismissing the Medicaid piece, Vinson closed this section of the opinion expressing sympathy for the federalist spirit of the states’ argument:

I appreciate the difficult situation in which the states find themselves. It is a matter of historical fact that at the time the Constitution was drafted and ratified, the Founders did not expect that the federal government would be able to provide sizeable funding to the states and, consequently, be able to exert power over the states to the extent that it currently does. To the contrary, it was expected that the federal government would have limited sources of tax and tariff revenue, and might have to be supported by the states. This reversal of roles makes any state-federal partnership somewhat precarious given the federal government’s enormous economic advantage. Some have suggested that, in the interest of federalism, the Supreme Court should revisit and reconsider its Spending Clause cases. See Lynn A. Baker, The Spending Power and the Federalist Revival, 4 Chap. L. Rev. 195-96(2001) (maintaining the “greatest threat to state autonomy is, and has long been, Congress’s spending power” and “the states will be at the mercy of Congress so long as there are no meaningful limits on its spending power”). However, unless and until that happens, the states have little recourse to remaining the very junior partner in this partnership.

#MORE#

UPDATE II: Vinson rejects the administration’s argument that the health insurance market is so “unique” that the government should be granted special Commerce Clause powers (the last sentence is great). 

Uniqueness is not an adequate limiting principle as every market problem is, at some level and in some respects, unique. If Congress asserts power that exceeds its enumerated powers, then it is unconstitutional, regardless of the purported uniqueness of the context in which it is being asserted. Second, and perhaps more significantly, under Lopez the causal link between what is being regulated and its effect on interstate commerce cannot be attenuated and require a court “to pile inference upon inference,” which is, in my view, exactly what would be required to uphold the individual mandate. For example, in contrast to individuals who grow and consume marijuana or wheat (even in extremely small amounts), the mere status of being without health insurance, in and of itself, has absolutely no impact whatsoever on interstate commerce (not “slight,” “trivial,” or“indirect,” but no impact whatsoever) — at least not any more so than the status of being without any particular good or service. If impact on interstate commerce were to be expressed and calculated mathematically, the status of being uninsured would necessarily be represented by zero. Of course, any other figure multiplied by zero is also zero. Consequently, the impact must be zero, and of no effect on interstate commerce. 

Nor does Vinson accept the administration’s reasoning that not having insurance itself constitutes “an economic decision” — putatively because individuals have engaged in “market timing” by deciding how and when to pay for medical services should they become sick:

The problem with this legal rationale, however, is it would essentially have unlimited application. There is quite literally no decision that, in the natural course of events, does not have an economic impact of some sort. The decisions of whether and when (or not) to buy a house, a car, a television, a dinner, or even a morning cup of coffee also have a financial impact that — when aggregated with similar economic decisions — affect the price of that particular product or service and have a substantial effect on interstate commerce. To be sure, it is not difficult to identify an economic decision that has a cumulatively substantial effect on interstate commerce; rather, the difficult task is to find a decision that does not.

Lastly, Vinson rejects the argument that the mandate is constitutional via the Necessary and Proper Clause, because it is necessary to guarantee other aspects of the ACA:

Ultimately, the Necessary and Proper Clause vests Congress with the power and authority to exercise means which may not in and of themselves fall within an enumerated power, to accomplish ends that must be within an enumerated power.

On the issue of the severability of the individual mandate from the rest of the ACA, Vinson rules that:

It wouldbe impossible to ascertain on a section-by-section basis if a particular statutory provision could stand (and was intended by Congress to stand) independently of the individual mandate. The interoperative effects of a partial deletion of legislative provisions are often unforseen and unpredictable. For me to try and “second guess” what Congress would want to keep is almost impossible. 

[. . .]

In sum, notwithstanding the fact that many of the provisions in the Act can stand independently without the individual mandate (as a technical and practical matter), it is reasonably “evident,” as I have discussed above, that the individual mandate was an essential and indispensable part of the health reform efforts, and that Congress did not believe other parts of the Act could (or it would want them to) survive independently. I must conclude that the individual mandate and the remaining provisions are all inextricably bound together in purpose and must stand or fall as a single unit. The individual mandate cannot be severed. 

UPDATE III: The one question I’ve been getting most is why the ruling didn’t enjoin the ACA all together. Simply put, Vinson assumes the good faith of the government in enforcing the law as it is read by the court, making separate injunction “unnecessary.”

Injunctive relief is an “extraordinary”. . . and “drastic” remedy. It is even more so when the party to be enjoined is the federal government, for there is a long-standing presumption “that officials of the Executive Branch will adhere to the law as declared by the court. As a result, the declaratory judgment is the functional equivalent of an injunction.” . . . (“declaratory judgment is, in a context such as this where federal officers are defendants, the practical equivalent of specific relief such as an injunction . . .since it must be presumed that federal officers will adhere to the law as declared by the court”) (Scalia, J.) (emphasis added).There is no reason to conclude that this presumption should not apply here. Thus, the award of declaratory relief is adequate and separate injunctive relief isnot necessary.

Whether that faith is misplaced remains to be seen.



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