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Health Care

States Challenging Health Care Act Petition High Court For Expedited Review

WASHINGTON, D.C. - (Mealey's) States challenging the Patient Protection and Affordable Care Act (PPACA) filed a petition on Sept. 28 for writ of certiorari with the U.S. Supreme Court, saying an 11th Circuit U.S. Court of Appeals decision affirming that the individual mandate contained in the act is unconstitutional did not go far enough (States of Florida, et al. v. United States Department of Health and Human Services, et al., No. N/A, U.S. Sup.). 

The states have asked the court to grant an expedited review. 

In January, the U.S. District Court for the Northern District of Florida granted summary judgment to 36 states that challenged the constitutionality of the law.  The federal government appealed. 

A split 11th Circuit panel on Aug. 12 affirmed a lower court finding that the individual mandate contained in the PPACA is unconstitutional but reversed a holding that the provision is not severable from the rest of the act.  The court also affirmed the lower court's finding that the act's expansion of Medicaid is constitutional. 

In their petition, the states urge the Supreme Court to grant plenary review, saying that of the other challenges to the act working their way through the system, this is the only case to address both fundamental questions "that go to the heart of our system of limited government and the Constitution's division of authority between the federal government and the States." 

The states challenge the PPACA's expansion to Medicaid; the employer mandates, which impose penalties upon states that do not offer their employees a federally mandated level of insurance; and the individual mandate, which requires nearly all individuals to maintain health insurance or pay a penalty. 

In their petition, the states say the 11th Circuit correctly held that the individual mandate is unconstitutional, but say the court should grant review to confirm that all the other limits on Congress' enumerated powers are "not rendered nugatory by a limitless spending power."  By conditioning all of the states' federal Medicaid funding upon agreement to substantially expand the states' Medicaid programs, the act "passes the point at which pressure turns into compulsion and achieves forbidden direct regulation of the States," they add. 

Also, the court should grant certiorari to consider whether Congress may treat states no differently from any other employer for the purposes of mandates without running afoul of the Constitution's fundamental structural limits, the states say. 

Finally, the court should grant certiorari to examine the 11th Circuit's erroneous severability decision.  Four courts have struck down the mandate, and each of those courts has reached different conclusions as to how much of the remainder of the PPACA should remain in place, the states say.   

"Given the fundamental reordering of the health care market worked by the ACA, the extent to which the Act survives is every bit as practically, if not doctrinally, important as whether the mandate is constitutional," the states say. 

The 11th Circuit's severability analysis is inconsistent with Supreme Court precedents and leaves the entire act in place - even provisions that the federal government has conceded cannot be divorced from the individual mandate, the states say. 

Granting certiorari in this case gives the court the best opportunity to consider the constitutionality of the mandate and the severability question that has arisen, the states say.

[Editor's Note:  Full coverage will be in the Oct. 5 issue of Mealey's Managed Care Liability Report.  In the meantime, the petition is available at or by calling the Customer Support Department at 1-800-833-9844.  Document #31-111005-012B.  For all of your legal news needs, please visit] 

Download the document now: - Document #31-111005-012B - Document #31-111005-012B 

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