On March 23, 2010, the ACA was enacted into law and quickly plunged into seemingly never-ending, ever-evolving litigation. If you’ve found our site, you’re most likely not a lawyer, which makes it a bit more challenging to understand how we’ve gotten to this point in health law as it regards the ACA.
Two key points that every individual should know: (1) the requirement that every state expand Medicaid was deemed unconstitutional however, the U.S. Supreme Court (SCOTUS) ruled that states could opt-in to the expansion [34 states including D.C. have expanded Medicaid]; and (2) the individual mandate is constitutional and still the law of the land [the Tax Cuts and Jobs Act repeals the financial penalty for not having insurance, but does not repeal the language of the mandate].
Below are some of the big milestones in the ACA’s legal history.
- April/May 2010: Immediately following the passage of the ACA, the Virginia state legislature passes a law to nullify (aka invalidate) the individual mandate provision in their state. Virginia Attorney General Ken Cuccinelli sued HHS Secretary Sebelius in the U.S. District Court for the Eastern District of Virginia, who filed a motion to dismiss the lawsuit by arguing that states cannot simply pass laws to get around certain federal laws. AG Cuccinelli filed a counter-motion arguing that health insurance was not commerce as intended by the U.S. Constitution and not subject to Congressional regulation. [This is a great primer on the Commerce Clause for those who want to know more].
- November 2010: A federal judge (Judge Moon) in Virginia (Western District) declared the individual and employer mandates constitutional. His basis for this ruling was that the challenge was premature since neither mandate would be enforced until 2014.
- December 2010: A federal judge (Judge Hudson) in Virginia (Eastern District) ruled the individual mandate unconstitutional but did not block implementation of the law. The Obama Administration appealed to the U.S. Court of Appeals for the Fourth Circuit.
- January 2011: A federal judge (Judge Vinson) in Florida ruled the ACA in its entirety unconstitutional because he found the individual mandate provision to be “inextricably bound” to the other provisions of the ACA. Thus, he ruled the entire law unconstitutional. [This issue of “severability”, or whether the individual mandate could be found unconstitutional but the ACA was a whole could still stand, became a flash point when the case came before the U.S. Supreme Court (SCOTUS)].
- February 2011: A federal judge (Judge Kessler) in D.C. rejected a challenge to the ACA from 5 individuals who claimed it violated the Religious Freedom Restoration Act (RFRA) and that the individual mandate exceeded Congress’s ability to regulate interstate commerce.
- August 2011: The Florida ruling was appealed and upheld in part by the 11th Circuit Court. The three judge panel found the individual mandate unconstitutional but held it could be severed from the ACA, allowing the rest of the law to stand. The U.S. Department of Justice appeals to SCOTUS.
- September 2011: The U.S. Court of Appeals for the Fourth Circuit reversed Judge Hudson’s decision and ruled that Virginia lacked subject-matter jurisdiction to bring the case. [Essentially, states cannot pass laws that supersede federal laws and since that’s what VA did, they lacked the legal standing to argue this case.] Virginia submitted a petition of certiorari from SCOTUS and was denied.
In November 2011, SCOTUS granted certiorari to parts of the three appeals—Florida v. HHS addressed the constitutionality of Medicaid expansion; HHS v. Florida addressed the Anti-Injunction Act; and National Federation of Independent Business (NFIB) v. HHS addressed the constitutionality of the individual mandate and the issue of severability. Nearly 6 hours of oral argument were heard over a three-day period, March 26-28, 2012.
The Court’s opinion in the consolidated case was delivered on June 28, 2012. In a 5-4 decision, the case was affirmed in part and reversed in part–which is to say that SCOTUS agreed with some of the lower court’s rulings and disagreed with others.
- The Anti-Injunction Act does not bar this challenge to the constitutionality of the mandate.
- The individual mandate is constitutional [Five Justices voted in the affirmative: Chief Justice Roberts, and Associate Justices Ginsburg, Breyer, Sotomayor, and Kagan].
- The Medicaid expansion is unconstitutional [Seven Justices voted in the affirmative: Chief Justice Roberts, and Associate Justices Breyer, Kagan, Alito, Scalia, Thomas, and Kennedy].