Providers follow of the reform law anf moer forward while many staters use rulling to pull back for mandates
Conservative state leaders declared open revolt on the Patient Protection and Affordable Care Act last week after a sweeping federal court ruling out of Pensacola, Fla., that, if upheld on appeal, would invalidate the entire law.
“There is no current plan to implement Obamacare,” said Brian Hughes, spokesman for newly elected Florida Gov. Rick Scott, a Republican and former healthcare executive who opposed the reform law long before he took office last month. “He hopes and believes that it will continue to be declared unconstitutional or it will be repealed.”
State officials in Idaho, Utah and Wisconsin issued similar reform refusals last week, even though U.S. District Judge Roger Vinson declined to issue an injunction blocking implementation of the law in light of his conclusion.
When asked what Scott’s advice would be to the state’s 210 community hospitals whose business the law is transforming, Hughes said the governor would not be issuing advice to hospitals.
Legal observers, in fact, disagreed sharply on exactly what Monday’s ruling even means, cre- ating uncertainty for the healthcare regulatory environment. Days after the ruling was issued, Virginia officials sought to fast-track a legal challenge of the law to the U.S. Supreme Court.
However states respond, hospital executives said they would continue pushing forward. “If the law stands, the implementation dates will stand,” said Richard Morrison, regional vice president of government and public affairs of the 20-hospital Florida Division of Adventist Health System. “If you’re planning for it to be overturned, but it isn’t, you’re going to have a hard time in the new environment in 2014.”
That’s when many of the reform law’s goals become laws, such as setting up state-based insurance exchanges, promoting the expansion of state Medicaid programs and requiring private citizens to buy federally approved healthcare insurance plans, among many others.
In a 78-page opinion issued Jan. 31, Vinson declared the healthcare reform law void, ruling that its mandate for individuals to buy insurance overstepped Congress’ power to regulate interstate commerce and that the mandate could not be severed from the broader legislation
Though it was the fourth such ruling from a district court judge, and the second to find individual mandate in the law unconstitutional, the Pensacola case was the most closely watched nationally because it featured 26 states as plaintiffs and dozens of legislators and interest groups joining with their own friend-of-the-court briefs.
And Vinson was the first to judge the legislation fatally flawed. He wrote that the complex law was like “a finely crafted watch” and that removing specific provisions would have unforeseen consequences. In contrast, U.S. District Judge Henry Hudson in Richmond, Va., likewise found the mandate unconstitutional but also that the law could stand without it, writing in a ruling issued Dec. 13.
Vinson made clear that he viewed the legal fight not as a battle over healthcare access, but rather the tendency of government powers to expand beyond legally conscripted bounds unless kept in check by the courts.