A Flurry of Hearings in Health Law Cases

Since Congress passed a national health overhaul last year, 31 separate legal challenges have been filed against it.  But one of the cases, brought by Florida and joined by 25 Republican governors, is most likely to go to the U.S. Supreme Court and seal the fate of the controversial law. 

In that case ( Florida v. HHS ), Federal District Court Judge Roger Vinson declared the so-called "individual mandate" unconstitutional, and ruled that requiring nearly everyone to purchase health insurance was so integral to the law that the entire statute should be scrapped. 

This week, that case was heard on appeal in Atlanta, where a three-judge panel asked lawyers in the case to answer the central question, The New York Times reported . If the federal government has the authority to require Americans to purchase health insurance, how does the Constitution restrict the government from requiring other kinds of purchases and activities? 

The Atlanta hearing was the third appeals court proceeding in a complex legal battle that has cast a cloud of uncertainty over states' role in implementing the sprawling law. Last week, a court of appeals in Cincinnati considered a ruling from a federal court in Michigan that upheld the law. In May, a Richmond court heard appeals of two separate lower court cases with conflicting rulings. In the months ahead are two other appeals hearings scheduled for July 13 and September 23, according to a Kaiser Health News scoreboard of court activity. 

So far, five federal court decisions have been rendered in the cases: three for the law and two against it. Twelve cases have been dismissed by federal courts and decisions are pending in nine cases. 

In the first strike against the health law, a case brought by Virginia Attorney General Ken Cuccinelli ( Commonwealth of Virginia v. Kathleen Sibelius ) was decided against the individual mandate. Judge Henry Hudson ruled that the mandate was unconstitutional, but stopped short of overturning the law. In April, the U.S. Supreme Court denied a request by Cuccinelli to bypass lower courts and go straight to the high court. 

In all of the cases, governors and other opponents of the health law argue the federal government does not have the power to levy a tax fine on people for failing to purchase health insurance. If that were the case, there would be no limit to what the government could require citizens to do, they say. Technically, they argue Congress' power to regulate interstate commerce — the legal basis for the individual mandate — does not include penalizing "inactivity." 

But in a White House blog post the day before the Atlanta hearing, President Obama's assistant for health care policy, Stephanie Cutter, wrote:  "Individuals who choose to go without health insurance are actively making an economic decision that affects all of us. When people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab."