What's next for states in health care ruling?

  • Article by: AMY GOLDSTEIN and N.C. A IZENMAN , Washington Post
  • Updated: February 1, 2011 - 9:38 PM

Officials in some of the 26 states affected interpreted the practical application differently.

A day after a federal judge struck down the government's plan to overhaul the health-care system, Wisconsin Attorney General J.B. Van Hollen issued a stern statement: "This means that, for Wisconsin, the federal health care law is dead," and that his state "was relieved of any obligations or duties" to carry out the statute.

Colorado Gov. John Hickenlooper, a Democrat, on the other hand, pointed to the 700 people in his state with serious medical problems who already found insurance under the law. "Who goes to these people," the governor said, "and tells them, 'Sorry, a judge in Florida has decided we now need to put you out in the cold?' "

Wisconsin and Colorado are among the 26 states joined in the legal challenge that prompted Monday's opinion by U.S. District Judge Roger Vinson in Pensacola, Fla., that the law is invalid because it goes too far in requiring most Americans to buy health insurance. The opposing reactions reflect striking disagreement over the ruling's practical effects.

Officials in Idaho and Florida, the state that initiated the lawsuit in March, said the ruling gives them the freedom to stop the work they have begun to put the law into effect. "We are not going to spend a lot of time and money with regard to trying to get ready to implement it," said Florida Gov. Rick Scott, a Republican.

Meanwhile, the governors of Georgia, Iowa and Mississippi said they did not think the court decision gave them license to stop work on the law, in part because the ruling is destined to be appealed to higher courts. "The state cannot halt midstream, because that would be irresponsible," said Brian Robinson, communications director for Georgia Gov. Nathan Deal, a Republican. "It would put us too far behind if our litigation is not successful in the end." Officials in some of the other 26 participating states said they simply have not yet determined what the ruling means in practice.

Why it's matters

The interpretations are significant because, under the ruling, only the direct parties to the case potentially are exempt from the law's requirements, said the plaintiff's attorney, David Rivkin. At issue, he said, are sweeping changes to the nation's health-care system that the law delegates to states. They include an expansion of Medicaid, the public insurance program for low-income Americans, so that it becomes available to people with higher incomes. They also include the design of insurance "exchanges," marketplaces through which individuals and small businesses will be able to buy coverage. Both changes are to take effect in 2014 and require intricate preparations.

However, Rivkin said, the ruling does not touch any provisions of the law that relate to insurance companies and employers. This means, for instance, that the opinion does not jeopardize some aspects of the law that already have gone into effect, including the ability of young adults to remain longer on their parents' insurance policies.

Senate Republicans seek vote today

As states struggled to parse the practical meaning of the judge's ruling, the decision elated congressional Republicans, who, as the court battle progresses, are waging a parallel effort to dismantle the law.

The House, where Republicans became the majority last month, already has passed a bill to repeal the law. Senate Republican leaders said they intend to try Wednesday to force the same measure to a vote in the Senate, where Republicans are unlikely to win passage.

Also Wednesday, Senate Majority Whip Richard Durbin, D-Ill., is scheduled to lead a hearing in the Senate Judiciary Committee to examine the constitutionality of the law. Democrats maintain that the law is constitutional, while Republicans maintain that the insurance requirement exceed Congress's constitutional limits.

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