Yesterday, a federal judge in Florida ruled in favor of 26 states that sued the federal government to overturn the new health care reform law—the Affordable Care Act (ACA). The judge ruled that the law is unconstitutional because it requires individuals to buy insurance or face tax penalties. Further, and unlike the earlier ruling in Virginia, the Florida judge chose to rule not solely on the so-called individual mandate portion of the law, but rather on the entire ACA. In the judge’s ruling, he said ACA is so dependent upon the mandate that the entire law is unconstitutional since the law would not work without it. Notably, the courts in two other states earlier ruled in favor of ACA’s constitutionality.

Judge Roger Vinson in the Florida case yesterday said it would be a “radical departure” from existing law to give Congress power to order people to buy something, as opposed to merely regulating activity once someone has entered the economic stream, reported CBS News legal analyst Jan Crawford.

The judge’s ruling that the entire 2,000-plus–page law is unconstitutional was unexpected as well. Typically, in determining the constitutionality of a law, judges employ a concept called “severability” and make as narrow a ruling as possible. So, even if they rule that part of a law is unconstitutional, they sever that piece out and leave the other parts in place. Broader rulings than simply excising the unconstitutional portions are often decried as judicial activism. As reported on CBS News, Vinson concluded he couldn’t sever the unconstitutional individual mandate provision from the broader law, and so as a result the entire law must fall. In my observation, and for practical purposes, without the individual mandate, the law won’t work. There must be universal coverage to finance other provisions, like coverage for pre-existing conditions.

Joining the coalition in the Florida case were: Iowa, Kansas, Maine, Ohio, Wisconsin, and Wyoming, in addition to Alabama, Alaska, Arizona, Colorado, Georgia, Indiana, Idaho, Louisiana, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Pennsylvania, South Carolina, South Dakota, Texas, Utah, and Washington.

From here, the case ruled on yesterday will likely be appealed to the U.S. Supreme Court, where some pundits suggest it may be fast-tracked to get a ruling as early as this fall. The only thing that is clear is a significant split in the federal decisions.

When all of this shakes out, it could be a real mess. If some parts are constitutional and others aren’t, it will cause significant problems because so much is interrelated. If it is all struck down, many will be upset who worked to get it passed, while others will be pleased that the courts sided with their opposing view. Many on both sides agree there are significant good elements in ACA, such as the elimination of pre-existing conditions and the ability for parents to keep their kids on the parents’ insurance to age 26 years. While APhA remained neutral on the bill, we also feel that the many pharmacy-friendly provisions have the ability to help a lot of people, and don’t want them struck down. The political debate will likely escalate over the next few months, so your participation and support are more important than ever. We will stay focused on ensuring Congress understands and values the services pharmacists have to offer the American people.