Friday, December 19, 2014

A Silver Lining for Health Reform in the Florida Ruling

Reports of health reform's legal demise are greatly exaggerated. Last Monday's decision by a federal judge in Florida actually changed very little. It invalidated one part of the law, but that determination has no immediate legal effect. At the same time, it put another key provision on a firmer legal footing.

A Silver Lining for Health Reform in the Florida Ruling

Reports of health reform’s legal demise are greatly exaggerated. Last Monday’s decision by a federal judge in Florida actually changed very little. It invalidated one part of the law, but that determination has no immediate legal effect. At the same time, it put another key provision on a firmer legal footing.

A closer look at the case shows what I mean.

Judge Roger Vinson found that the provision in the law requiring everyone to have insurance is unconstitutional. But, he is not the only judge to rule on that question. He is one of four who have ruled in different cases. One of the other judges agreed with him that the insurance mandate should go, but the other two determined that it is fine.

The four judges who have issued the rulings all preside in federal district courts. This means they are all at the same level, so none of the rulings takes precedence over the others. Judge Vinson’s decision is the latest, but it has no special status.

The four decisions will all be appealed, and the Supreme Court will ultimately make the final call. When all is said and done, that is the only ruling that really counts.

Aside from the mandate, Judge Vinson found that everything else in the health reform law is valid. Yes, he called for the entire law to be scrapped, but that is not because any of it beyond the mandate raises constitutional problems. Instead, he determined that the fate of the law is a matter of all or nothing. He refused to “sever” the mandate, so in his view, this one invalid provision drags down everything else along with it.

It is significant that Judge Vinson found no constitutional problems anywhere else in the law. The 26 attorneys general who brought the lawsuit specifically asked him to invalidate not just the mandate, but also the part of the law that expands Medicaid. This is the health insurance program for the poor that is administered by the states with federal funding. The health reform law requires states to broaden Medicaid coverage to many more people in order to continue receiving those funds.

The Medicaid expansion has been a rallying point for health reform opponents, who see it as an insidious extension of federal power. They have now decisively lost on that point before a Republican judge. On the constitutionality of extending Medicaid, health reform supporters have gained important support.

Expanding Medicaid is a key part of health reform. It will account for half of the people who will newly gain coverage. Standing on its own, the expansion would reduce the number of uninsured Americans by one-third.

So, while Judge Vinson ruled against one controversial part of health reform, the mandate, he reinforced the legal basis for another, the Medicaid expansion. In doing so, he actually gave both sides legal ammunition as the case winds its way to the Supreme Court. This is far from the complete repudiation of health reform that some have made the ruling out to be.

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About this blog

Check Up covers regional health news and a wide array of healthcare topics from pharmaceutical happenings to patient safety. Read about some of our bloggers here.

Portions of this blog may also be found in the Inquirer's Sunday Health Section

Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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