Appeals Court Rejects Health Reform Law's Insurance Mandate

A federal appeals court has ruled unconstitutional the provision of President Obama's health care reform law that would require all U.S. citizens to purchase health insurance coverage beginning in 2014. This decision by the U.S. Court of Appeals for the 11th Circuit follows a previous ruling by the 6th Circuit Court of Appeals, which voted in favor of the "minimum coverage" mandate in June (Psychiatric News, August 5). The appellate courts' contradictory findings suggest that the Supreme Court will be forced to weigh in with a final determination on the constitutionality of the Patient Protection and Affordable Care Act.

"The ruling by the 11th Circuit is a significant blow but by no means the death of health care reform," said Robert Cabaj, M.D., chair of APA's Council on Advocacy and Government Relations. "The action is likely to lead to a full Supreme Court review sooner than originally thought, and that is likely a good step."

In a 2-1 decision rejecting the individual coverage provision, Chief Judge Joel Dubina and Circuit Judge Frank Hull ruled that a health insurance mandate is a violation of congressional authority under the Constitution's Commerce Clause. "This economic mandate represents... the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives," wrote Dubina.

Despite the court's rejection of the Affordable Care Act's minimum coverage provision, Dubina and Hull ruled that the rest of the law is acceptable as written. This overturns the U.S. District Court for the Southern District of Florida's earlier ruling in the case, which deemed the individual mandate as not being severable from the rest of the law.

The 11th Circuit's ruling is also notable in that Hull is a Democratic appointee of President Bill Clinton. Prior to the 6th Circuit's ruling in June, in which a Republican-appointed judge voted in favor of the mandatory insurance provision, federal court hearings on the Affordable Care Act resulted in decisions being made along the party lines of their respective judges.

The suit was brought against the departments of Health and Human Services, Labor, and Treasury by the attorneys general of 26 states, as well as two private individuals and the National Federation of Independent Business.