Clearing Up Short-Term Uncertainty About Health Reform Implementation

To implement, or not to implement? For the past few months, that was the question. As discussed in a previous post, the lawsuits over the constitutionality of the Patient Protection and Affordable Care Act (PPACA) are leaving a lot of confusion in their wake as they make their way through the federal court system. Much of the confusion was resolved this month – at least temporarily – when Federal District Judge Roger Vinson issued a clarification of his ruling on Florida v. Sebelius.

After Vinson issued a ruling declaring the entire PPACA unconstitutional back on January 31, 2011, some states took it as a cue to stop implementing the health care law. A few states even returned the grant money they received from the Department of Health and Human Services (HHS) to fund implementation of the law. A few weeks after Vinson’s ruling, the Department of Justice (DOJ) filed a motion asking Vinson to clarify his ruling. (Vinson originally stated his ruling against PPACA was declaratory, not an injunction, but he also argued his ruling should be treated as an injunction.)

Judge Vinson responded by issuing a stay of his own ruling on March 3rd, 2011. He argued that treating the DOJ clarification request as a request for a stay would “save time in this time-is-of-the-essence case.” Yes, he did intend for his ruling to be interpreted as an official reason to halt implementation, and he was not pleased that it took the DOJ two and half weeks to issue a motion for clarification.

Vinson’s clarification positions the case back in more familiar legal territory – a stay of the Vinson decision means that the states must move forward with implementation until a higher court tells them otherwise. Alaska is a good illustration of this point. Governor Sean Parnell responded to Vinson’s January ruling by stating that Alaska was “bound” by the Florida decision to halt implementation of the law. That same week, the deadline for a health insurance exchange planning grant from the HHS expired, and Alaska became the only state in the nation not to receive the $1 million grant. After Vinson’s clarification, Governor Parnell acknowledged that implementation had to move forward, stating:

“Now Judge Vinson has issued a stay… What this means for Alaska is that our administration will treat the federal health care law as being in place, as we are directed by the judge in the lawsuit to which our state was a party. Going forward, Alaska will make decisions on a case-by-case basis whether the state will undertake with our own money or with federal money how to implement the provisions of the law.”

The final word will not come until the U.S. Supreme Court has a chance to weigh in on the case – and that is unlikely to happen this year. So for the moment, we are back to our regularly scheduled program – health reform is the law of the land and implementation must move forward.