11th Circuit Rules Health Care Individual Mandate Unconstitutional

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A three-judge appellate panel in Atlanta on Friday ruled a key pillar of the Affordable Care Act, Obama’s 2010 health care reform law, unconstitutional. In a lengthy opinion, two judges, one appointed by President Bill Clinton and one by George H.W. Bush sided with 26 states that argued that the individual health insurance mandate violates the Commerce Clause of the U.S. Constitution, which empowers the federal government to regulate economic activity between states. A third judge, also a Clinton appointee dissented on whether the nationwide requirement to buy health insurance, set to go into effect in 2014, is permissible.

Friday’s opinion is the second handed down — and the first to strike down the individual mandate — at the appellate level, and a significant blow to the Obama Administration. A prior ruling from the 6th Circuit, upheld the law. In 11th Circuit’s majority opinion, Judges Joel Dubina and Frank Hull argued that compelling lifetime purchase of an expensive product exceeds precedented federal power. “The power that Congress has wielded via the Commerce Clause for the life of this country remains undiminished. Congress may regulate commercial actors. It may forbid certain commercial activity. It may enact hundreds of new laws and federally-funded programs, as it has elected to do in this massive 975-page Act,” they wrote. “But what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.”

Dubina and and Hull also ruled against the Obama administration’s argument that the mandate’s fees constitute a tax rather than a penalty, an almost unanimous finding across various court cases, but broke with the law’s opponents, and the district judge who handled this case before them, on an expansion of Medicaid and the key issue of “severability” — whether or not the rest of the law can be “severed” from the individual mandate and remain in place even if the mandate is struck down. “In light of the stand-alone nature of hundreds of the Act’s provisions and their manifest lack of connection to the individual mandate, the plaintiffs have not met the heavy burden needed to rebut the presumption of severability,” they wrote. “We therefore conclude that the district court erred in its wholesale invalidation of the Act.”

In his dissent, Judge Stanley Marcus argued that the majority ignored years of Supreme Court precedent and a “heavy presumption of constitutionality” traditionally used by the courts in considering laws passed by Congress, pointing to one of the same cases (Gonzales v. Raich) that conservative 6th Circuit Judge Jeffrey Sutton used in his lengthy defense of the mandate in June.

Back in June, when the 11th Circuit first heard arguments on this case, Kate Pickert wrote that “the ruling that comes out of Atlanta could be the strongest indicator yet of whether the ACA will ultimately be allowed to stand.” The composition of the three judge panel, she argued, could foreshadow a split decision or a break from the clear pattern that Democrat-appointed judges rule for the law and Republican-appointed judges rule against it. Her prediction proved prescient. With one notch for and one notch against the individual mandate at the appellate level, the Affordable Care Act seems to be continuing its steady march toward the Supreme Court.