Florida Healthcare Reform

With Monday’s ruling by a federal judge that the healthcare reform law is unconstitutional, legal experts foresee a showdown in the Supreme Court, where the outcome could go either way.

Judge Roger Vinson, of the U.S. District Court for the Northern District of Florida, in Pensacola, on Monday ruled that the healthcare reform law is unconstitutional, siding with the 26 states that sued to block enforcement of the Affordable Care Act (ACA).

That makes four total rulings on the law: two that upheld the law, one that struck down the individual mandate portion of the law, and Monday’s decision, which struck down the law in its entirety. Another 12 courts have dismissed the case.

“All of these cases are merely station stops on the way to the Supreme Court,” Dr. Daniel Blumenthal, a community health professor at Morehouse School of Medicine in Atlanta, told ABC News/MedPage Today in an e-mail.

The ruling by Vinson is the harshest legal action yet against the ACA because, unlike the recent decision by a Virginia judge stating that the individual mandate portion of the ACA violates the Constitution, Vinson ruled the entire law “void” because the individual mandate provision can’t be separated out from the rest of the law.

The individual mandate — which requires everyone to buy insurance by 2014 or else pay a penalty — exceeds Congress’ authority under the Commerce Clause of the Constitution, which regulates interstate commerce, Vinson wrote in his decision.

Vinson agreed with the states involved in the lawsuit that the government cannot force individuals to participate in the stream of commerce — in this case, the health insurance market.

The federal government responded that at some point, every U.S. citizen will seek medical care, and if that person chooses to not have insurance, the cost of his or her medical care is passed on to those with insurance. Thus, a choice to not participate in the commerce of healthcare doesn’t actually exist.