By Carol Duh and Terrence Leong
As a sea of white coats gather in front of the Supreme Court today to support the ACA, it is important to reflect upon how we arrived at this point in the first place. After two years of a good fight and amid a divided Congress, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law two years ago on March 23, 2010. The passage of the ACA into law triggered an immediate legal response from multiple parties, government and private alike. The most controversial aspect of the law has been the individual mandate, which required all Americans to purchase a minimum level of health insurance.
Florida et al. v. Dep’t of Health and Human Services represents the most significant legal challenge to the ACA. In this lawsuit, 26 states filed a joint lawsuit to overturn the individual mandate. There were two important rulings that emerged from this district court:
- The individual mandate provisions of the ACA fell out of the scope of Congress’s enumerated constitutional powers
- The individual mandate provision of the ACA could not be severed from the rest of the Act.
The implication of this ruling was that in order to protect the ACA, we have to protect the individual mandate. The Florida litigation remains by far the largest in terms of number of states that signed on as parties, but it is not the only challenge – the Fourth, Sixth, and D.C. Circuits have all ruled in one way or another that the ACA’s individual mandate is constitutional.
The district court judge ruling in this case found the ACA itself to be unconstitutional.
This decision was appealed before this week, and a divided three-judge panel of the Eleventh Circuit held:
- The individual mandate was unconstitutional.
- The individual mandate WAS severable from the rest of the ACA.
This opened the question of whether or not we could protect the ACA without protecting the individual mandate, the most controversial aspect of this law.
On November 14, 2011, the Supreme Court voted to grant “certiorari” to Florida et al. Certiorari, or the Supreme Court’s agreement to hear a case, is a big deal. The vast vast majority of petitions for the Supreme Court are denied. In fact, the grant rate is 1.1% (Brings new meaning to the 99%!). This case is a big deal to us as doctors, but it’s a big deal to our court system as well, and holds large influence on future cases as well.
The two big questions the Court will address are:
- Whether the individual mandate is constitutional
- Whether the individual mandate, if unconstitutional, is severable from the remainder of the ACA.
Stay tuned this week as this case unfolds, and keep these questions in mind and how it will affect our goals to expand health care coverage to as many of the people we care for as possible!!
 Sheryl Gay Stolberg & Robert Pear, Obama Signs Health Care Overhaul Into Law, The New York Times, March 23, 2010, at A19.
 Florida ex. rel. Bondi v. U.S. Dep’t of Health and Human Services, 780 F.Supp.2d 1256 (N.D. Fla. 2011).
 See Virginia ex rel. Cuccinelli v. Sibelius, 656 F.3d 253 (4th Cir. 2011) (vacating district court’s ruling that individual mandate was unconstitutional on lack of subject-matter jurisdiction); Thomas More Law Center v. Obama, 651 F.3d 529 (6th Cir. 2011) (affirming district court’s finding that the ACA was constitutional); Seven-Sky v. Holder, 661 F.3d 1 (D.C. Cir. 2011) (affirming district court’s finding that the individual mandate constitutional under the Commerce clause).
 Florida ex rel. Atty. Gen. v. U.S. Dep’t of Health and Human Services, 648 F.3d 1235 (11th Cir. 2011).
 Florida et al. v. Dep’t of Health and Human Services, 132 S.Ct. 604 (2011).