Healthcare reform lawsuit ruling expected

The health policy world is fixated on Florida today as a federal judge gets ready to decide whether a multi-state challenge to the healthcare reform law can move forward.

Attorney General Bill McCollum's lawsuit, filed the same day President Obama signed healthcare reform into law, is the main legal challenge. Challengers include 21 states and the National Federation of Independent Business.

The Florida lawsuit includes six counts, but the main issue at play is whether the law's individual mandate, requiring people to be insured starting in 2014, is constitutional.

The controversial mandate is central for the law to function because without it, private insurers say they'd go broke if they had to follow the new law's requirements on covering sick people.

Florida Northern District Senior Judge Roger Vinson has said he will enter his written order on the administration's motion to dismiss the case on or before Oct. 14. The judge is widely expected to allow the individual mandate challenge to go forward.

Other federal judges have already issued divergent rulings, however, making it difficult to know what to expect.

Last Thursday, a federal district judge in Michigan upheld the mandate's constitutionality in a separate lawsuit.

The conservative Thomas More Law Center and four individuals had sued the White House over the mandate, arguing it violates the commerce clause of the Constitution.

But Detroit-based U.S. District Judge George Caram Steeh disagreed, finding the mandate does not constitute "an improperly apportioned direct tax."

"The minimum coverage provision of the Health Care Reform Act contains two provisions aimed at the same goal," Steeh wrote. "Congress intended to increase the number of insureds and decrease the cost of health insurance by requiring individuals to maintain minimum essential coverage or face a penalty for failing to do so."

In August, however, Judge Henry Hudson of the United States District Court for the Eastern District of Virginia denied the administration's request to throw out Attorney General Ken Cuccinelli's lawsuit, also filed Sept. 23.

"Unquestionably, this regulation radically changes the landscape of health insurance coverage in America," Hudson wrote.

A hearing on the Virginia case is scheduled for Monday.

The counts in the Florida case are as follows:

Count One: Unconstitutional mandate that all individuals have healthcare insurance coverage or pay a penalty. (Unconstitutional under Commerce Clause (Art. I Sec. 8) and under the 9th and 10th Amendments concerning principles of federalism and dual sovereignty).

Count Two: Unconstitutional mandate that all individuals have healthcare insurance coverage or pay a penalty. (Unconstitutional under the 5th amendment's due process clause).

Count Three: Violation of constitutional prohibition of unapportioned capitation or direct tax. (Unconstitutional under Art. I Sections 2 and 9 and Amendments 9 and 10).

Count Four: Unconstitutional coercion and commandeering of the states as to Medicaid. (Unconstitutional under Art. I and Amendments 9 and 10).

Count Five: Unconstitutional coercion and commandeering as to healthcare insurance. (Unconstitutional under Art. I and Amendments 9 and 10).

Count Six: Unconstitutional interference with the states' sovereignty as employers and performance of government functions. (Unconstitutional under Article I and Amendments 9 and 10).

Vinson has already laid out a timeline should he allow the lawsuit to move forward.

"Assuming the case survives dismissal in whole or in part," he wrote last month, "the parties have until 11/4/2010 in which to move for summary judgment (and the (defendants) may file their answer at the same time); the opposing party will have until 11/23/2010 to respond; and the moving party will have until 12/6/2010 to file any Reply."

It's unknown what time the judge will issue his ruling, but it's worth remembering that Pensacola — where the lawsuit was filed — is on Central Time.