NEJM: Healthcare reform jurisdictional issues are not cut-and-dry

The jurisdictional issues of the Patient Protection and Affordable Care Act (PPACA) are currently cloudy with a low chance of predictability in how the Supreme Court will resolve them, according to a perspective paper published Oct. 5 in the New England Journal of Medicine.

By the numbers, Timothy Stoltzfus Jost, JD, and Mark. A. Hall, JD, from Washington & Lee University School of Law in Lexington, Va., and Wake Forest University Schools of Law and Medicine in Winston-Salem, N.C., respectively, wrote that approximately 30 lawsuits have been filed challenging the law.

“[R]eview by the Supreme Court by June 2012 now appears likely, given the government’s petition for such review filed on Sept. 28,” Jost and Hall wrote.

Most cases claim that Congress exceeded its constitutional authority in enacting the PPACA, but the Constitution also limits the authority of the federal courts. Jurisdictional issues lurk in the challenges. According to the authors, at least 10 cases have been dismissed for lack of jurisdiction, with four dismissals coming from or affirmed by federal appellate courts.

One issue relates to “standing," meaning whether the plaintiffs have grounds to challenge. “The Supreme Court has interpreted the Constitution's 'case or controversy' requirement to mean that federal courts lack jurisdiction unless a plaintiff can demonstrate an actual or imminent 'injury in fact' that the courts can redress,” the authors wrote. “Since the requirement that Americans obtain minimum health insurance coverage — the primary focus of the lawsuits — won't go into effect until 2014, with penalties for those who don't comply first assessed in 2015, it may appear that no one is currently injured.”

Related to, yet distinct, from standing is the legal doctrine of “ripeness,” meaning a court could decline to hear a case even if a case has standing if the case is filed prematurely before a controversy is fully developed.

“For instance, the ripeness requirement would bar current litigants from challenging the PPACA's eventual application to their particular financial and family situations, but the cases filed to date are not such ‘as-applied’ challenges; rather, they challenge the minimum-coverage requirement ‘on its face,’ claiming that it's invalid in most or all applications,” Jost and Hall stated. “Most courts have been willing to hear PPACA challenges now on this basis.”

But not all ripeness concerns can be swept aside. Ripeness receives special protection in tax cases, under a federal statute called the Anti-Injunction Act (AIA), which states that “no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person, whether or not such person is the person against whom such tax was assessed.”

The PPACA's individual mandate is enforced through the federal income tax system. The authors posed: Is the minimum-coverage requirement a tax, a penalty, an assessment, an exaction or none of the above, and what difference does that make?

“Both the federal government and the law's challengers want this question decided on the constitutional merits and therefore argue that the AIA doesn't apply or that it should be waived,” they wrote, continuing that the government also contends, however, that the minimum-coverage requirement is a valid exercise of Congress's constitutional power to tax.

“It thus has the most difficult argument to make—that the requirement is imposed through a constitutional tax but that the AIA's reference to ‘any tax’ does not bar a challenge now. The government argues that the AIA does not apply to all exactions in the tax code and that Congress didn't intend it to apply to the PPACA. The Fourth Circuit rejected both these arguments, but the Sixth Circuit agreed with the first point. The losing parties in both cases are petitioning for Supreme Court review," Jost and Hall wrote.

“All the litigants — the Obama administration, the states and the private litigants — want a definitive ruling on the question of whether Congress constitutionally adopted the minimum-coverage requirement,” the authors concluded. “But first the courts must decide whether they can constitutionally decide this question.”

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