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Another judge rules health care law unconstitutional

A second federal judge ruled Monday that it had been unconstitutional for Congress to enact a health care law that requires all Americans to obtain commercial insurance, evening the score at 2-2 in the lower courts as the conflicting opinions begin their path to the Supreme Court.

But unlike a Virginia judge in December, Judge Roger Vinson of the U.S. District Court in Pensacola, Fla., concluded the insurance requirement was so "inextricably bound" to other provisions of the Affordable Care Act that its unconstitutionality required the invalidation of the entire law..

''The act, like a defectively designed watch, needs to be redesigned and reconstructed by the watchmaker," Vinson wrote.

The judge declined to immediately enjoin, or suspend, the law pending appeals, a process that could last two years. But he wrote that the federal government should adhere to his declaratory judgment as the functional equivalent of an injunction. That left confusion about how the ruling might be interpreted in the 26 states that are parties to the legal challenge.

The insurance requirement, known as the individual mandate, does not take effect until 2014. But many new regulations are already operating, such as a requirement that insurers cover children with pre-existing health conditions. States also are actively preparing for a major expansion of Medicaid eligibility and the introduction of health insurance exchanges in 2014.


David B. Rivkin Jr., a lawyer for the states, said the ruling relieves the plaintiff states of any obligation to comply with the health law. "With regard to all parties to this lawsuit, the statute is dead," Rivkin said.

But White House officials declared the opinion should not deter the ongoing rollout of the law. "Implementation would continue apace," a senior administration official said. "This is not the last word by any means."

At the same time, Stephanie Cutter, an assistant to the president, noted in a post on the White House blog that the ruling had struck down the entire law. She called it "a plain case of judicial overreaching," and added: "The judge's decision puts all of the new benefits, cost savings and patient protections that were included in the law at risk."

The Justice Department, which represents the Obama administration in the health care litigation, said it was exploring legal options to clarify the uncertainty, including requesting a stay of the decision, either from Vinson himself or from the U.S. Court of Appeals for the 11th Circuit.

On Capitol Hill, Republicans sent out a stream of e-mail messages praising the ruling, while Sen. Richard Durbin, D-Ill., said he would convene a Judiciary Committee hearing on Wednesday to examine the constitutionality of the law.

In a 78-page opinion, Vinson held the insurance requirement exceeds the regulatory powers granted to Congress under the Commerce Clause of the Constitution. Vinson wrote that the provision could not be rescued by an associated clause in Article I that gives Congress broad authority to make laws "necessary and proper" to carrying out its designated responsibilities.

''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," Vinson wrote.

In a silver lining for the Obama administration, the judge rejected a second claim that the new law violates state sovereignty by requiring states to pay for a fractional share of a Medicaid expansion that is scheduled for 2014.


Vinson, the first judge to address that question, dismissed the contention that states were being illegally commandeered by the federal government. He said they always have the option, however impractical, to withdraw from Medicaid, a joint state and federal insurance program for those with low-incomes.

''The states have little recourse to remaining the very junior partner in this partnership," the judge wrote.

The judge's ruling came in the most prominent of the more than 20 legal challenges mounted against some aspect of the sweeping health law, which was enacted last year by a Democratic-controlled Congress and signed by President  Obama in March.

The plaintiffs include governors and attorneys general from 26 states, all but one of them Republican, as well as the National Federation of Independent Business, which represents small companies. Officials from six states joined the lawsuit in the past month after shifts in party control brought by November's midterm elections.

The ruling by Vinson, a senior judge who was appointed by President Ronald Reagan, solidified the divide in the health litigation among judges named by Republicans and those named by Democrats.

In December, Judge Henry E. Hudson of U.S. District Court in Richmond, Va., who was appointed by President George W. Bush, became the first to invalidate the insurance mandate. Two other federal judges put on the bench by President Bill Clinton, a Democrat, have upheld the law.

Vinson's opinion hangs on a series of Supreme Court decisions that have defined the limits of the Commerce Clause by granting Congress the authority to regulate "activities that substantially affect interstate commerce."

The plaintiffs in the Florida case characterized the insurance requirement as an unprecedented attempt to regulate inactivity because citizens would be assessed an income tax penalty for failing to purchase a product.


Justice Department lawyers responded that a choice to not obtain health insurance is itself an active decision that, taken in the aggregate, shifts the cost of caring for the uninsured to hospitals, governments and privately insured individuals.

In his decision, Vinson wrote, "It would be a radical departure from existing case law to hold that Congress can regulate inactivity under the Commerce Clause." If Congress has such power, he continued, "it is not hyperbolizing to suggest that Congress could do almost anything it wanted."

The Pensacola case now likely heads to the 11th Circuit Court of Appeals in Atlanta, considered one of the country's most conservative appellate benches. The Richmond case is already with another conservative court, the 4th Circuit Court of Appeals in Richmond, which has set oral arguments for May.

That court will consider diametrically opposed rulings from courthouses situated 116 miles apart, as it was a judge in Lynchburg, Va., Norman K. Moon, who issued one of the two decisions upholding the law. Meanwhile, the 6th Circuit Court of Appeals in Cincinnati is already receiving briefs on the other decision backing the law, which was delivered by Judge George C. Steeh in Detroit.

Vinson's ruling further arms Republicans in Congress who are waging a fierce campaign against the health care act. The new Republican majority in the House voted early this year to repeal the law, a largely symbolic measure that is given no chance in the Democratic-controlled Senate.

The Obama administration argues the insurance mandate is essential to its goals of covering more than 30 million uninsured and offering protections to those with pre-existing health conditions. Unless everyone is required to have insurance, the administration contends, consumers might simply wait until they are sick to enroll, undercutting the actuarial soundness of risk pooling and leading to an industry "death spiral."

But the mandate's legal and political problems have prompted a few Democratic senators to join Republicans in exploring alternatives that would encourage citizens to buy insurance without requiring it.

For instance, people could be given a narrow window to enroll, and those who miss the deadline would face lengthy waiting periods for coverage. Alternately, those who apply late and are eligible for government tax credits under the law coverage could be penalized through a reduction of their subsidies.

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