Judge Roger Vinson’s Monday decision was not the first time a federal judge struck down the portion of the federal health care reforms that requires most Americans to either buy insurance or pay a penalty.

A Virginia judge ruled against that provision in December, in a case separate from the one brought in Pensacola by Florida and 25 other states. But one line, on page 76 of Vinson’s 78-page opinion, summarizes what sets his decision apart: “Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void.”

The Virginia decision struck down the mandate more narrowly, leaving the rest of the law intact.

The Patient Protection and Affordable Care Act, Vinson wrote, is like a “finely crafted watch,” with many moving parts, but one essential piece: the individual mandate, without which countless other parts cannot function.

Peter Suderman of Reason points out that supporters of the bill have argued that the mandate may be essential to the overall effort.

Vinson wrote in his opinion that picking apart all the pieces of health care reform that rely on the mandate would be judicial activism — “a quasi-legislative undertaking” that would strip the bill of its original intent:

The statute is, after all, called “The Patient Protection and Affordable Care Act,” not “The Abstinence Education and Bone Marrow Density Testing Act.” The Act, like a defectively designed watch, needs to be redesigned and reconstructed by the watchmaker.

Vinson rejected the federal government’s argument that not having health insurance constituted an economic decision that could be regulated by Congress under the Constitution’s commerce clause. If that were the case, he wrote, the clause could have virtually “unlimited application”:

There is quite literally no decision that, in the natural course of events, does not have an economic impact of some sort. The decisions of whether and when (or not) to buy a house, a car, a television, a dinner, or even a morning cup of coffee also have a financial impact that — when aggregated with similar economic decisions — affect the price of that particular product or service and have a substantial effect on interstate commerce.

One conservative blogger has argued that if the ruling stands, it “could go down as an important landmark in the history of American liberty. But that’s a big ‘if.’”

The New York Times has traced the various legal and political challenges to health care reform. Vinson ruled against one aspect of Florida’s that set it apart from other states: its attack on the health care reform law’s expansion of Medicaid, which the states argued would impose new costs.

Vinson wrote that while he sympathized with the states on this point, he rejected their contention that federal funding for the program amounted to coercion because exiting the program would costs the states billions of dollars a year:

Indeed, a survey of the legal landscape revealed that there was “very little support for the plaintiffs’ coercion theory argument” as every single federal Court of Appeals called upon to consider the issue has rejected the coercion theory as a viable claim.

Accusations and influences

The Center for Public Integrity has pointed out that Vinson holds as much as $75,000 in health care industry investments (though none of the companies it lists are insurers).

Other obervers have argued that politics, or perhaps ideology may have played a role in his decision. Liberal blogs, meanwhile, have accused Vinson of “borrowing” his ideas from conservative groups opposed to health care reform.

Dave Weigel notes:

Their administration’s lawyers are hoping that the next judges who take this case are more concerned with Supreme Court precedent than with, say, the Federalist Papers. “In a frequently cited law review article,” writes Vinson, “one Constitutional scholar has painstakingly tallied each appearance of the word ‘commerce’ in Madison’s notes on the Constitutional Convention and in The Federalist, and discovered that in none of the ninety-seven appearances of that term is it ever used to refer unambiguously to activity beyond trade or exchange.” The scholar being quoted here is Georgetown’s Randy Barnett, the intellectual force behind the Repeal Amendment.

What now?

The Obama Administration has announced plans to appeal the ruling, which will head to the Eleventh Circuit Court of Appeals in Atlanta, Ga.. The constitutionality of health care reform is likely to be decided by the Supreme Court.

If the challenge prevails, supporters of reform may have to consider alternatives to the mandate along with other possible changes to the law. Policy experts have contemplated alternatives that may be more politically popular and less likely to face a successful constitutional challenge, but generally agree these alternatives are weaker.

What happens in the meantime? The mandate doesn’t kick in till 2014, but other portions are already in effect. Vinson declined the states’ motion seeking an injunction halting the implementation of the law.

Courts have typically assumed that the federal government will follow the law, Vinson wrote, so his ruling should be “the functional equivalent of an injunction.” However, because the case is going to be appealed, the administration could seek a stay of any injunction until the lawsuits are resolved. An informed discussion of the procedural issues can be found here.

Bottom line, according to The Washington Post (emphasis added):

David Rivkin, a conservative lawyer in Washington who represents the plaintiffs, said that the 26 states that are party to the lawsuit are no longer subject to any of the law’s requirements – unless the federal government obtains a stay of Vinson’s order from an appeals court. White House officials firmly rejected that view. “Implementation will proceed apace,” one senior White House official said in a background briefing for reporters.

Not so in Florida, though. Gov. Rick Scott has said he’s waiting for the Supreme Court’s decision before taking any steps to implement reform, such as setting up exchanges for people to buy health insurance.

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