President Obama's administration said it would appeal the healthcare… (Larry Downing, Reuters )
Reporting from Washington — A federal judge in Florida dealt President Obama's healthcare overhaul a sweeping blow Monday, ruling the law unconstitutional because of its requirement that Americans have health insurance starting in 2014.
U.S. District Judge Roger Vinson declined to suspend the law but said the government should abide by his ruling, potentially complicating implementation in some states.
DOCUMENTS: Read Judge Vinson's decision
The Washington lawyer who represented the 26 states in the lawsuit said the ruling freed them from complying with its provisions, including requirements not to cut people from their Medicaid programs, as some governors say they want to do.
"For the 26 states that were parties to this suit, the entire statute is dead," said David B. Rivkin Jr. "The decision has immediate force, and it means all the new Medicaid stuff is gone."
Obama administration officials disputed Rivkin's analysis and indicated they would appeal Vinson's decision.
"We don't believe this kind of judicial activism will be upheld and we are confident that the Affordable Care Act will ultimately be declared constitutional," Assistant to the President Stephanie Cutter said in a White House blog post.
With lower federal courts divided, the fate of Obama's signature domestic achievement will probably be decided by the Supreme Court, which could rule as soon as next year.
In separate lawsuits, two other federal courts have ruled that the law's insurance mandate is permissible under the so-called Commerce Clause of the Constitution.
A third federal judge in Virginia ruled in December that the mandate was unconstitutional, but stopped short of invalidating the whole law.
Parts of the law have already taken effect, including drug discounts for seniors, tax credits for small businesses and insurance regulations that prevent insurers from denying coverage to sick children.
In Arizona, a spokesman for Republican Gov. Jan Brewer, who is pressing the Obama administration for permission to cut people from its Medicaid rolls to save money, said the state would not abandon that effort.
"We are not going to act unilaterally," spokesman Matthew Benson said. Arizona is among the states that joined Florida in its lawsuit.
Vinson's rejection of the mandate as an overextension of government power appears certain to further energize Republican efforts to dismantle the law.
In often colorful language that invoked the Boston Tea Party, Vinson, an appointee of President Reagan, rejected the administration's argument that Congress' broad powers to regulate commerce allowed lawmakers to require Americans to buy health insurance.
"The existing problems in our national healthcare system are recognized," Vinson wrote in his 78-page decision. "There is widespread sentiment for positive improvements that will reduce costs, improve the quality of care, and expand availability in a way that the nation can afford. Regardless of how laudable its attempts may have been to accomplish these goals in passing the act, Congress must operate within the bounds established by the Constitution."
Vinson warned that if Congress could require health insurance, it could also decide for Americans "whether and when (or not) to buy a house, a car, a television, a dinner or even a morning cup of coffee."
"It is difficult to imagine," Vinson said, "that a nation which began, at least in part, as the result of opposition to a British mandate giving the East India Company a monopoly and imposing a nominal tax on all tea sold in America would have set out to create a government with the power to force people to buy tea in the first place."
The insurance mandate in the healthcare law was designed to spread risk more broadly and control insurance premiums, enabling the federal government to offer consumers other protections — such as prohibiting insurers from denying coverage to those with preexisting medical conditions.
Without a mandate, healthy Americans can avoid buying insurance until they get sick. Those who do buy insurance tend to be sicker than the general population. That phenomenon, which has occurred in several states that have guaranteed the right to coverage without any insurance requirement, has helped drive up premiums.
"People who make an economic decision to forgo health insurance do not opt out of the healthcare market," said Cutter of the White House. "As Congress found, every year millions of people without insurance obtain healthcare they cannot pay for, shifting tens of billions of dollars in added cost onto those who have insurance and onto taxpayers."
But the mandate remains the most unpopular feature of the healthcare overhaul and has helped galvanize a nationwide Republican attack on the law.
Nineteen states joined Florida in the suit last year: Alabama, Alaska, Arizona, Colorado, Georgia, Indiana, Idaho, Louisiana, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington.
In January, six more states joined the suit after new GOP governors took office: Ohio, Kansas, Wyoming, Wisconsin, Maine and Iowa.
Except for Louisiana, which is represented in the suit by its Democratic attorney general, the states are represented by Republican governors or attorneys general.
Several dozen leading consumer groups, medical associations and patient advocates joined the Obama administration in defending the law. They include the American Medical Assn., the American Hospital Assn., the Consumers Union and the March of Dimes Foundation.