On Jan. 31, a federal court judge made one of the most significant decisions in U.S. Court history, and the action will have far-reaching effects on government. U.S. District Court Judge Roger Vinson ruled that PPACA was unconstitutional based on the interstate commerce law – the result of a lawsuit in which the plaintiffs argued that Congress overreached its boundaries in requiring that consumers buy health insurance. The plaintiffs – 26 states, two individuals, and the National Federation of Independent Business – also argued that the costs of Medicaid expansion that PPACA calls for would overwhelm state Medicaid budgets. But then, Vinson went further: He determined that the law had no "severability" language, and therefore voided the entire act because all parts of the mandate were "inextricably bound" to other provisions in the law. In simple terms, it's either all or none. The judge chose all.
So, where do we go from here?
The administration's reaction
Many believe that the order means that, under the ruling, the law is void and cannot be implemented from this point forward. Some reports indicate that the judge declined to stop implementation of the law, as the plaintiffs requested. There is some confusion here, in that the White House, the Department of Health and Human Services, and the Centers for Medicare and Medicaid services believe differently, and will move forward with implementation. The administration, as expected, will seek a stay. In the meantime, the White House website says in no uncertain terms, "Implementation will continue."
Solutions to the judge's order and the White House defiance are mostly theoretical at this moment. Many proponents and opponents of the order are offering their varying interpretations. This type of debate will continue over the coming weeks and months, so don't count on a quick, concrete interpretation anytime soon.
According to a story from the Tribune Washington bureau, "Vinson rejected a second claim by the states that the health care overhaul unlawfully forced them to expand their Medicaid insurance programs for the poor, another key part of the new law." That is significant, and will surely become a major part of the health care fight. The judge's opinion stated that it is difficult to prove whether the expansion would bankrupt the states, or that Congress is not forcing the states to participate in the program.
Congressional repeal efforts
One day after the ruling, Senate Minority Leader Mitch McConnell introduced the Senate version of the House PPACA repeal bill, tying it into a Federal Aviation Administration bill. In defense of the tactic, it was made in response to Sen. Harry Reid's threat to not bring up a repeal version in the Senate, given that too many senators who planned to run for re-election in 2012 would have to make a pretty tough decision on where they would go after having originally voted for the bill.
Meanwhile, the House, regardless of the judge's order (and yet buoyed by the order), continues to move forward with several committees designing replacement parts to the bill in anticipation of a total blockage of full repeal. It also is prepared to defund any portion of PPACA with which House members do not agree.
Obviously, the White House will appeal the judge's ruling, and in so doing, delay a decision on quickly moving the matter to the Supreme Court. Most observers agree that this will not happen for one-and-a-half to two years.
Other Republican actions
In the meantime, two Senate Republicans are preparing a bill that would allow the states to opt out of the law. The legislation, created by Sens. Lindsey Graham of South Carolina and John Barrasso of Wyoming, would allow states to opt out of the individual mandate. In somewhat of a surprise move, the president indicated he would consider allowing the states to opt out if they met certain conditions.
