Florida Stops Implementing PPACA

WASHINGTON BUREAU - Florida has shut down implementation of the Patient Protection and Affordable Care Act (PPACA) as a result of a recent federal court ruling declaring the law to be unconstitutional.

Florida Insurance Commissioner Kevin McCarty said Tuesday at a meeting of the Florida Health Insurance Advisory Board (FHIAB)that PPACA, a major component of the federal Affordable Care Act package, "is not now in effect in Florida."

McCarty said he is temporarily suspending an application for a waiver or adjustment of new health insurance medical loss ratios.

"We are going to take stock and see what our options are," McCarty said.

McCarty said he told Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, that Florida would not be spending any of the funds it had been allocated to implement the insurance exchange program.

He said at the meeting that he had concerns about possible inappropriate federal interference with implementation of the exchanges in Connecticut, and "yesterday's decision just made it a cinch."

Florida Gov. Rick Scott, R, said, "We're not going to spend a lot of time and money with regard to trying to get ready to implement that until we know exactly what is going to happen.... And I hope and I believe that either it will be declared unconstitutional or it will be repealed."

Normally, under the Federal Rules of Civil Procedure, a judge's ruling cannot be enforced for 14 days after entry of judgment.

In theory, if the federal government proceeds with implementing PPACA without seeking a stay, a PPACA opponent could ask a federal court to cite U.S. Health and Human Services Secretary Kathleen Sebelius for contempt of court.

U.S. District Judge Roger Vinson, the Pensacola, Fla., who declared PPACA to be uncharted PPACA watersunconstitutional Monday, compared the law to "a finely crafted watch" in which there are "too many moving parts" for him to "dissect out the proper from the improper, and the able-to-stand-alone from the unable-to-stand-alone."

Vinson said the PPACA provision that could require some individuals to own a minimum level of health coverage in 2014 or pay a penalty exceeds the authority granted to Congress by the commerce clause of the U.S. Constitution, but he issued a declaratory judgment against the entire law. He suggested that the Obama administration view the judgment as the "functional equivalent" of an injunction requiring it to suspend implementation.

At the Florida hearing, Deputy Insurance Commissioner Mary Beth Senkewicz said that, in the wake of the decision, the new medical loss ratio requirements and other PPACA provisions are not constitutional in Florida.

She said this would change if the White House appeals the decision to the 11th Circuit Court of Appeal and secures a stay of the Pensacola court's ruling.

SENATE HEARING

In related news, members of the Senate Judiciary Committee today debated whether the government can make individuals buy health insurance at a 4-hour hearing on the constitutionality of PPACA.

Sen. Patrick Leahy, D-Vt., chairman of the committee, said the authority of Congress to act is "well-established by the specific powers vested in Congress by Article I, Section 8 of the Constitution, by prior acts of Congress like Social Security and Medicare, by longstanding precedent established by the courts, and by the history of American democracy."

"This act was neither novel nor unprecedented, but rested on the foundation used over the last century to build and secure the social safety net," Leahysaid.

Leahy said the individual mandate was originally proposed by Sen. John McCain,

R-Ariz., during the Clinton administration, and was part of the Massachusetts health reform package supported by former Massachusetts governor and Republican presidential candidate Mitt Romney.

Sen. Charles Grassley, R-Iowa,the highest ranking Republican onthe panel, said there are many constitutional questions about the individual mandate.

"What is clear is that if this law is constitutional, Congress can make Americans buy anything that Congress wants," Grassley said. "The individual mandate is the heart of the bill. As my friend, Senator [Max] Baucus, said at the markup: the absence of a requirement of 'a shared responsibility for individuals to buy health insurance guts health care reform'. ... The individual mandate is the reason that the new law bars insurance companies from denying coverage based on pre-existing conditions, and the sponsors made the mandate the basis for nearly every provision of the law."

Sen. Richard Durbin, D-Ill., noted that other major works of legislation, such as the Civil Rights Act of 1964 and the law that created the federal minimum wage, ran into trouble in the lower courts before they were upheld by the U.S. Supreme Court.

"I believe the same will happen with the Affordable Care Act," Durbin said.

Although 2 federal district court judges have found the law to be unconstitutional, 2 have found the law to be constitutional, and 12 have dismissed challenges to the law, Durbin said.

"How is it possible that federal judges who not only study the Constitution but swear to uphold it can read its words and draw such different conclusions?" Durbin asked.


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