Senior Judge Vinson, of the Northern District of Florida, held that the entire Patient Protection and Affordable Care Act “ACA” is unconstitutional, because the individual responsibility requirement or individual mandate regulates “inactivity,” and therefore is outside the scope of the Commerce Clause as well as the Necessary and Proper Clause. Going beyond the recent Virginia decision which invalidated only the mandate, the Florida court held that since there is no severability clause, the entire law is void. The constitutionality of the expansion of Medicaid was upheld pursuant to Congress’s Spending Clause power, though the judge disparaged federal requirements on state agencies in exchange for federal dollars. The judge awarded only declaratory and not injunctive relief. Florida v. U.S. Dept of Health and Human Services, 2011 WL 285683 (N.D. Fla. Jan 31, 2011). Judge Vinson was nominated by President Reagan.
The crux of the decision is the judge’s conclusion that Congress lacks the power under the Commerce Clause to regulate the decision not to purchase health insurance. Vinson attempts to ground that holding in prior jurisprudence by observing that Commerce Clause cases have noted that Congress has the power to regulate broad categories of activities and classes of activities.
The foil to his logic is that “categories” and “classes” of activities can include freeloading on the market. A “category” or “class” of activities does not exclude the failure to act. But Judge Vinson interpreted “category” or “class” of activities to require an affirmative action being regulated.
The ACA imposes a financial penalty for the failure to purchase health insurance. The court viewed this as a penalty for “inactivity.”
Contrast the ACA with the criminal penalties imposed for the failure to register as a sex offender under the Sex Offender Registration and Notification Act (SORNA). SORNA’s validity under the Commerce Clause is based on its applicability to people who travel from one state to the next, even though the penalties are based entirely on the “inactivity” of failing to register. Courts of appeals have uniformly rejected constitutional challenges to SORNA. See U.S. v. Shenandoah, 595 F.3d 151, 156 (3d Cir. 2010) (citing cases).
Judge Vinson rejected the argument that the health care market is unique. He stated that people cannot opt out of many markets, including markets for food and transportation. He hypothesized that if the ACA is constitutional, then Congress could mandate the purchase of broccoli to improve people’s health. He likewise rejected the economic nature of the decision not to purchase health insurance, stating that virtually all decisions can have an economic impact at some point. He stressed the importance in his view of limiting the reach of the Commerce Clause to reserve powers to the states.
Similar to the Virginia decision, Vinson held that since the individual mandate was not authorized under the Commerce Clause or any other enumerated power of Congress, it could not be justified under the Necessary and Proper Clause. The court stated: “Ultimately, the Necessary and Proper Clause vests Congress with the power and authority to exercise means which may not in and of themselves fall within an enumerated power, to accomplish ends that must be within an enumerated power.”
The court upheld the constitutionality of the expansion of Medicaid, noting that while Supreme Court dicta suggested that some level of federal funding might be coercive, “every single federal Court of Appeals called upon to consider the issue has rejected the coercion theory as a viable claim.” Vinson stated that the Constitutional Founders did not anticipate the federal government’s “enormous economic advantage” over the states and the power it could therefore wield over the states. The court suggested that the Supreme Court revisit the issue and stated that until then, “the states have little recourse to remaining the very junior partner in this partnership.”
Turning to severability, the court used against the government its arguments that the individual mandate was necessary for the goals of the statute. The court stated that because the mandate is necessary for the purpose of the statute, the whole statute should be struck down along with the mandate. The court further stated that the lack of a severability clause in the final version, after one had been included in an earlier version “can be viewed as strong evidence that Congress recognized the Act could not operate as intended without the individual mandate.”
The court stated that it presumed the federal government would comply with the law as declared by a court and therefore declined to issue injunctive relief.