A U.S. appeals court in Atlanta will hear a lawsuit on Wednesday challenging the constitutionality of the healthcare reforms signed into law by President Barack Obama a year ago.
The suit, filed by more than half the states, could reach the Supreme Court during its 2011-12 term, which begins in October. Individuals, advocacy groups and hospitals have also sued.
What's at issue?
States like Virginia have passed, or are considering, legislation declaring that the healthcare law cannot be enforced in their states. State legislators in Maine, Montana, Nebraska, Oregon, Texas and Wyoming have introduced bills that establish penalties, including fines and jail time, for any agent seeking to enforce the healthcare law within their states' borders. North Dakota's legislature passed a "nullification" bill in April authorizing it to enact any measure necessary to prevent enforcement of the law.
The states' main concern is that the law permits the federal government to force people to buy things, in this case requiring that all Americans purchase health insurance or pay a penalty under the "individual mandate." The federal government counters that everyone will inevitably pay for healthcare, whether through insurance or during an emergency, and that without the individual mandate premiums will rise.
Key points
If the courts decide the individual mandate is unconstitutional, it is unclear if the mandate can be cut away from the law while leaving the other requirements intact. The states say that without the individual mandate, the law is rendered toothless.
Parts of the U.S. Constitution that have come into play are the Commerce Clause, which regulates commerce among states, the Supremacy Clause, which makes federal power supreme to states' power, and the 10th Amendment, which leaves to states all powers not explicitly granted to the federal government.
Some of the suits also focus on whether abortions are funded with taxpayer dollars under the law.
When Obama lobbied for the bill, he said there would not be a new tax associated with the individual mandate. The penalty for not having health insurance, though, is collected through tax filings and the federal government argues the fine is indeed a tax it is empowered to levy. States say the U.S. government does not have the authority to charge the fine and point to the discrepancy between Obama's statements and the U.S. government's arguments.
Current lawsuits
In Georgia, a lawsuit filed by 26 states and led by Florida Judge Roger Vinson said the requirement that individuals buy health insurance is unconstitutional. The 11th U.S. Circuit Court of Appeals will hear arguments on Wednesday in Atlanta. While Vinson said the entire healthcare law "must be declared void" because the requirement is inextricably linked to other parts of the law, he put his decision on hold pending appeal. Vinson had ordered the Obama administration to seek a fast-track review of its appeal.
In Virginia, a three-judge panel of the U.S. Court of Appeals for the 4th Circuit heard oral arguments in May challenging the recent ruling by U.S. District Judge Henry Hudson that the federal government cannot compel a person to buy health insurance. The judges, one of whom was appointed by Obama, sharply questioned if Virginia had the right to bring the suit just because it passed a state law saying its citizens were not required to purchase insurance. In a twist, both the federal government and Virginia had appealed Hudson's decision. Virginia says the judge erred by not throwing out the entire law.
The court also heard an appeal in a lawsuit filed by Liberty University, the Virginia college founded by conservative evangelical leader Jerry Falwell. A federal judge had ruled the requirement to have health insurance and a requirement some employers buy coverage for employees was legal under the U.S. Constitution's Commerce Clause.
Other rulings
Last week, the U.S. Court of Appeals for the 6th U.S. Circuit in Cincinnati heard an appeal in one of the first suits, filed by Michigan's Thomas More Law Center. One of the plaintiffs disclosed that she recently bought health insurance, and the panel of three judges is now trying to decide if there is still legal standing to sue. In October, a federal judge partly dismissed the suit, ruling Congress had the authority to enact the law under the Commerce Clause of the Constitution.
In April, the U.S. District Court in New Jersey decided two individuals who said they represented "we the people" did not have any standing to sue, primarily because they could not establish they had been harmed by the law. The court had already dismissed on December 9 a lawsuit filed by a cardiologist, a patient and a physicians' advocacy organization that had alleged the law violates the Constitution's Commerce Clause and the Fifth Amendment.
A California federal court dismissed a lawsuit, now before the 9th U.S. Circuit Court of Appeals, that said the healthcare law violates individual rights, increases taxes and violates physician-patient privileges, along with violating the Commerce Clause.
In November, U.S. District Court Judge David Dowd partially denied and partially granted a motion to dismiss a lawsuit filed by the U.S. Citizen's Association in Ohio. While he dismissed arguments that the law violates freedom of association, due process and privacy protections, Dowd is considering arguments that the law exceeds federal authority granted by the Commerce Clause.
At least 24 lawsuits have been filed in federal courts by states and private parties. One suit, Shreeve vs. Obama, was filed by a group of 25,000 individuals and entities.
(Sources: Court documents, governors' offices and Pacific Legal Foundation)