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Federal appeals judges show support for health care reform law

By Bill Mears, CNN Supreme Court Producer
  • Opponents of the health reform law and federal attorneys give oral arguments
  • One 4th Circuit appeals judge says it looks like a "slam dunk" for the federal government
  • A main question is whether people can be forced to buy health insurance

Richmond, Virginia (CNN) -- A federal appeals court panel expressed strong support Tuesday for the sweeping health care reform bill championed by President Barack Obama. It was the first appellate hearing on the law's constitutionality.

The cases are a certain prelude to eventual Supreme Court review.

Federal district judges in Virginia had earlier issued conflicting rulings on the whether key provisions of the Patient Protection and Affordable Care Act violate the Constitution, prompting the Richmond-based 4th U.S. Circuit Court of Appeals to now weigh in.

One controversial section known as the "individual mandate" would require most Americans to buy health insurance by 2014 or face financial penalties.

All three judges hearing the case, named to the bench by Democratic presidents, suggested the law is valid, despite objections from the state as well as private groups and individuals.

Past court rulings have affirmed "the significant federal authority in health care" said Judge Diana Gribbon Motz.

Judge Andre Davis said, "There was no doubt the individual mandate was necessary to Congress' mandate" in the area of reform legislation, calling the question a "slam dunk" in the federal government's favor.

The judicial panel was randomly chosen, but several health care reform advocates had broad smiles both before and after the 135-minutes public session, anticipating a victory. Several dozen protesters gathered outside the granite courthouse, many carrying signs opposed to the reform effort.

Various state and private challenges to the Patient Protection and Affordable Care Act are now before federal appeals courts across the United States. Another requirement mandates expansion of Medicaid, the low-income health program administered by the states.

The high court could be asked this fall to take formal jurisdiction over one or more health care appeals, and it could decide the matter perhaps by 2012, a presidential election year.

The three-judge panel Tuesday heard two separate cases, one filed by the Commonwealth of Virginia, the other by the private Liberty University, which bills itself as the largest Christian evangelical college in the world. The Liberty University plaintiffs, among other things, believe the law would allow taxpayer dollars to fund abortions, a claim the Obama administration rejects.

In oral arguments, Virginia officials said the Constitution's Commerce Clause does not give government the authority to force Americans to purchase a commercial product like health insurance that they may not want or need. The state equates such a requirement to a burdensome regulation of "inactivity." Virginia is one of the few states in the country with a specific law saying residents cannot be forced to buy insurance.

But Virginia's solicitor general Duncan Getchell struggled to justify state intervention on behalf of its citizens-- an issue known as standing. The judges suggested similar past court cases limited state options to challenge federal laws.

The Justice Department countered that since every American will need medical care at some point in their lives, individuals do not "choose" to participate in the health care market. Federal officials cite 2008 figures of $43 billion in uncompensated costs from the millions of uninsured people who receive health services, costs that are shifted to insurance companies and passed on to consumers.

But Motz wondered whether the federal government was assuming the role of "big brother" in pushing such wide-reaching legislation

Judge James Wynn suggested the law was properly forcing all Americans to be "responsible" for health costs nationwide, and that even an uninsured person should not "wait until you get sick and everybody suddenly has to take care of you." Wynn wondered if that, too, was a proper government role.

The issue could turn on whether foregoing medical insurance or coverage represents economic "activity"-- an area long considered proper for congressional oversight in interstate commerce. Virginia argues it is not, but the 4th Circuit panel was openly skeptical of that position.

A ruling would technically only affect those states covered by the 4th Circuit: Virginia, Maryland, West Virginia, North Carolina and South Carolina. But its impact would be felt nationwide, and set the tone for other courts considering similar issues. The circuit is about evenly split among Republican- and Democratic-appointed judges.

In June, a federal appeals court in Atlanta will hear arguments in a lawsuit filed by Florida and 25 other states over the law. A similar appeals court in Cincinnati will tackle the issue next month as well.

One pressing concern is whether parts of the law already in effect can continue to be enforced. Those sections currently being administered include small business tax credits, federal grants and consumer protection measures. The federal government wants to know whether these provisions can continue while the issue is under appeal, particularly in the 28 states that have filed suit.

Other questions that could prompt a high court review:

--If one provision of the law is found unconstitutional, does the entire act become invalidated?

--Should employers be forced to provide some level of health insurance to their workers?

--Can religious, moral, and other objections to the law be considered?

--Do Virginia and other states have "standing" or legal authority to bring their claims, or is congressional taxing authority ultimately exempt from such lawsuits?

Oklahoma and a range of private groups have also filed separate legal challenges that are concurrently working their way through federal courts around the country.

The Affordable Care Act has about 450 individual components, placing a number of new or revised regulations on states, private insurance companies, employers and individuals.

A federal judge in Florida in recent months found parts of the law unconstitutional, while a colleague in Michigan upheld the provisions.

Obama signed the act into law in March 2010, after promoting Democratic-led health reform efforts for months after taking office. The law is widely considered to be the signature legislative accomplishment of the president's first two years in office.

Among other things, the measure was designed to help millions of uninsured and underinsured Americans receive adequate and affordable health care through a series of government-imposed mandates and subsidies. The federal government stated in court briefs that 45 million Americans last year were without health insurance, roughly 15 percent of the country's population.

Critics have equated the measure to socialized medicine, fearing a bloated government bureaucracy will result in higher taxes and diminished health care services. About two dozen challenges have been filed in federal courts nationwide.

Health care reform, a top Democratic priority since the Truman administration, was passed by the last Congress in a series of virtually party-line votes. Opponents derisively labeled the measure "Obamacare." Republican leaders, who captured the House of Representatives in the midterm elections, have vowed to overturn or severely trim the law.

The current cases are Commonwealth of Virginia v. Sebelius (11-1057) and Liberty University v. Geithner (10-2347). Among federal appeals courts, the 4th Circuit has a reputation of issuing rulings relatively quickly, and a ruling in this case could come in the next few weeks.

An audio link to the arguments is at: