Legal Challenges

Implementation Briefs

Update: Legal Challenges to the Affordable Care Act — Liberty v. Geithner Petition for Rehearing

Categories: Implementation Update, Judiciary, Legal Challenges

Posted on October 25, 2012

One of a number of lawsuits filed in opposition to the ACA was Liberty University, Inc., et al. v. Geithner et al. Under this lawsuit in 2010, a private Christian university and a number of individual petitioners sued the government to block enforcement of the ACA’s employer requirement to provide health insurance coverage to employees, as well as the individual requirement to maintain health insurance coverage. The district court in the Western District of Virginia rejected all the plaintiffs’ claims, which included challenges based on the Commerce Clause, the Necessary and Proper Clause, the Tenth Amendment, the First Amendment, the Fifth Amendment, and the Religious Freedom Restoration Act (RFRA). On appeal, the Fourth Circuit held that the Anti-Injunction Act (AIA) barred federal courts...

Update: Legal Challenges to the Affordable Care Act’s Medicaid Maintenance of Effort Provisions

Categories: Implementation Update, Legal Challenges, Medicaid and CHIP

Posted on September 26, 2012

The Affordable Care Act (ACA), in addition to expanding coverage to individuals with incomes below 133 percent of the federal poverty level (FPL), includes provisions designed to preserve existing Medicaid coverage -- known as the maintenance of effort provision, or MOE -- until the ACA is fully implemented. The ACA’s MOE provision requires states to maintain their current Medicaid eligibility standards, methodologies, and procedures until the Secretary of the Department of Health and Human Services (HHS) determines that a state Exchange is fully operational. For children, the ACA’s MOE extends through September 30, 2019. States may reduce eligibly for certain non-pregnant, non-adult...

Congressional Budget Office and Joint Tax Committee Estimates of Cost and Coverage under the ACA after the Supreme Court Ruling in NFIB v. Sebelius and the Effects of H.R. 6079, the Repeal Obamacare Act

Categories: Implementation Update, Legal Challenges, Medicaid and CHIP

Posted on August 1, 2012

The Congressional Budget Office (CBO), the legislative branch agency responsible for estimating the cost of legislation, issued two reports on July 24th related to the Affordable Care Act (ACA). The first report, revised cost and health insurance coverage estimates for the ACA in the wake of the Supreme Court ruling in NFIB v. Sebelius[1]. In that ruling, the Court concluded the individual requirement to purchase health insurance coverage, while not a reasonable exercise of congressional Commerce Clause authority, is constitutional as a tax under congressional Spending Clause authority. The Court also held that the ACA’s Medicaid expansion, requiring states to cover all non-elderly individuals with incomes below 133[2] percent of the federal poverty level was unconstitutional. However, rather than striking the requirement, the Court precluded the Secretary of the Department of Health and Human Services (HHS) from enforcing the mandate by withholding all Medicaid funds. As a result of the ruling, states now have the option of expanding coverage to 133 percent of the federal poverty level (FPL), and will receive enhanced federal matching funds as provided under the law, but are not required to expand coverage.[3]

A Closer Look at the Medicaid Holding in NFIB v Sebelius: Key Implementation Questions

Categories: Health Insurance, Judiciary, Legal Challenges, Medicaid and CHIP, Tax Policy

Posted on July 3, 2012

In NFIB v Sebelius the United States Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA or the Act). At the same time, the decision adds a new dimension to the implementation of §2001(a) of the Act, which establishes expanded Medicaid eligibility for certain low-income people. This Implementation Brief begins with a discussion of exactly what the Court held in its Medicaid ruling. It then discusses the significance of the majority conclusion, as well as the key implementation questions that arise in the wake of this opinion.

Summary of the U.S. Supreme Court decision in the case of National Federation of Independent Businesses et al. v. Sebelius, Secretary of Health and Human Services, et al.

Categories: Health Insurance, Judiciary, Legal Challenges, Medicaid and CHIP, Tax Policy

Posted on June 28, 2012

The Supreme Court handed down its long-awaited ruling in the case of National Federation of Independent Businesses et al. v. Sebelius, Secretary of Health and Human Services, et al., upholding the individual requirement to maintain insurance coverage as a reasonable exercise of Congress’s taxing and spending authority and also upholding the constitutionality of the Medicaid coverage expansion. In a surprise coalition, Chief Justice Roberts was joined in his majority opinion by Justices Stephen Breyer, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan. The summary below describes the majority opinion, the concurring opinion (authored by Justice Ginsburg), and the dissenting opinion (written by Justice Scalia). Because the Court upheld the individual mandate, it never reached...

Legal Challenges to the Affordable Care Act: Tabular Summary of Supreme Court Amicus Briefs

Categories: Editor's Comment, Implementation Update, Judiciary, Legal Challenges

Posted on March 26, 2012

The table below summarizes all of the amicus briefs filed to date. HealthReformGPS has posted summaries for at least one of the briefs filed by the bolded amici below...

Maintenance of Minimum Essential Coverage

Categories: Health Insurance, Implementation Update, Legal Challenges

Posted on February 10, 2012

Approximately 49 million nonelderly Americans are uninsured. Of those, approximately 20 percent have the financial means to buy health insurance but decide not to and instead rely on emergency care when necessary; the rest desire insurance but are denied coverage or cannot afford it. Even though uninsured, some individuals in the latter group receive medical services, resulting in approximately $43 billion worth of uncompensated care costs. These costs are recouped through higher charges for health care services, thereby producing a cost-shifting effect that results in higher premiums for those who are insured. This cost shift is...

Constitutional Challenges Update: Florida et al. v United States Department of Health and Human Services

Categories: Health Insurance, Implementation Update, Judiciary, Legal Challenges

Posted on January 4, 2012

On November 14, 2011 the United States Supreme Court agreed to hear oral arguments on issues that have arisen as a result of more than two dozen legal challenges to the Affordable Care Act (ACA) that were filed upon or immediately following the March 2010 enactment of the health reform law. The Court will consider four constitutional issues related to the ACA: (1) whether Congress has the power under Article I of the Constitution to enact the coverage requirement; (2) if the coverage requirement is found unconstitutional, whether it is severable from the remainder of the ACA; (3) whether the ACA’s requirement that states expand Medicaid eligibility or risk losing federal funds is unduly coercive in violation of the Tenth Amendment; and (4) whether the individual coverage requirement is a tax for purposes of the Anti-Injunction Act, meaning that plaintiffs seeking to challenge the requirement must wait until it takes effect in 2014. Oral arguments are set for March 26-28, 2012, and a decision is expected by the end of the Court’s term in late June of 2012.

Legal Challenges Update: The Justice Department’s Petition for Writ of Certiorari in United States Department of Health and Human Services v. Florida

Categories: Health Insurance, Implementation Update, Judiciary, Legal Challenges

Posted on October 12, 2011

On September 28, 2011, the United States Justice Department (DOJ) asked the United States Supreme Court to review the decision of the court of appeals for the Eleventh Circuit striking down as unconstitutional what the DOJ terms the law’s “minimum coverage provision.” In seeking Supreme Court intervention, the DOJ sought review on two matters: first, whether Congress exceeded its Commerce Clause powers, as enhanced by the Necessary and Proper Clause; and second, whether the Anti-Injunction Act bars the challenges from proceeding in the first place.

Update: Legal Challenges to the Affordable Care Act

Categories: Health Insurance, Implementation Update, Judiciary, Legal Challenges

Posted on September 23, 2011

Since the enactment of the Affordable Care Act (ACA), at least 27 lawsuits have been filed challenging the constitutionality of various provisions of the law. While nearly half of the lawsuits have been dismissed on procedural grounds, three district courts have found provisions challenged to be constitutional, and three have found them to be unconstitutional. Previous HealthReform GPS Implementation briefs/updates have discussed these lower court decisions. Following appeals of each of these rulings, the United States Courts of Appeals in the Fourth, Sixth, and Eleventh Circuits have now issued decisions as well. Most importantly, the appellate decisions continue to reflect a split in judicial opinion regarding the constitutionality of the Affordable Care Act’s individual mandate. Other important issues addressed by the appellate rulings concerned the constitutionality of the ACA Medicaid expansion and the question of whether the trial court in the Virginia cases (Liberty University v. Geithner and Commonwealth of Virginia v. Sebelius) had the authority to hear the cases at all.

Update to Constitutional Challenges to Health Reform: Mead et al. v. Holder et al.

Categories: Implementation Update, Legal Challenges

Posted on March 2, 2011

A fifth U.S. District Court has issued a decision on a challenge to the constitutionality of the Patient Protection and Affordable Care Act (ACA) in Mead et al. v. Holder et al., finding the law is constitutional. Although legal challenges to the ACA have not been limited to the individual requirement to maintain health insurance coverage, the vast majority of cases have focused on this provision, commonly referred to as the individual mandate. To date, three district courts have held that Congress has the authority to require purchase of health insurance coverage as a reasonable exercise of its Commerce Clause powers, and two have struck down the provision as unconstitutional. A Florida district court has gone one step further, holding that the individual mandate, as an essential part of the ACA, was non-severable from the remainder of the Act and, as a result, struck down the entire statute.

Update to Constitutional Challenges to Health Reform: Florida et al. v. HHS

Categories: Implementation Update, Legal Challenges

Posted on February 3, 2011

Shortly after President Obama signed the Patient Protection and Affordable Care Act (ACA) into law, opponents filed a series of legal challenges in federal court. In a previous Implementation Brief we provided an overview of these legal challenges, identified provisions of the ACA that are the focus of challenges, discussed provisions of the Constitution that are the basis of these challenges, and provided brief histories of relevant Supreme Court rulings. The purpose of this brief is to provide an update on the status of the lawsuit filed by 26 states and other individuals in Florida et. al. v. HHS.

Legal Challenges to the Affordable Care Act

Categories: Legal Challenges

Posted on December 14, 2010

This is an updated version of a brief originally published on November 15, 2010. Shortly after President Obama signed the Patient Protection and Affordable Care Act (ACA)[1] into law, opponents of the law filed a series of legal challenges in federal court. This health reform implementation brief provides an overview of the legal challenges by identifying and providing summaries of the two major cases filed by states and select claims, not raised by the states, from other cases.