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States Lay Out Battle Lines In Health Care Suits


This is WEEKEND EDITION from NPR News. I'm Jacki Lyden.

This week, a federal judge in Virginia allowed that state's challenge to the Obama health care law to move ahead in court. But the legal dispute experts are really watching is in Florida, where 19 other states have filed court papers intensifying their fight to overturn the law on a much wider set of arguments.

NPR's Carrie Johnson reports.

CARRIE JOHNSON: To opponents of the new federal health care plan, the law represents a groundbreaking power grab by the federal government, one that should be fought all the way up to the Supreme Court. And they've got the sweeping rhetoric down already.

Mr. DAVID RIVKIN (Attorney): This case is about power, accountability, and about the future of our unique federalist system.

JOHNSON: That's David Rivkin. He's a lawyer who's helping Florida and 20 other states. They have banded together with a business group and small business owners who are suing to throw out the entire health care law. The arguments revolve around the same issue: whether the federal government is overreaching into the lives of people and industry.

Mr. RIVKIN: We feel that the statute if sustained would not just produce extremely bad results in the health care sector; it would fundamentally warp our constitutional architecture.

JOHNSON: Florida's lawsuit targets the individual mandate. It's a requirement that people buy health insurance or pay a penalty. Opponents argue that Congress overstepped its authority under the Constitution's commerce clause. The commerce clause usually comes into play when Congress wants to regulate economic activity.

But in the health care law, Congress moved to exert control over people's failure to act - in this case to buy insurance.

Mr. ROB WEINER (Attorney): The opponents say this is regulation of inactivity, and that's not right.

JOHNSON: Rob Weiner is leading the government's effort to defend the health care law.

Mr. WEINER: What it is, is everybody is going to need medical services -virtually everybody - and they're going to have to pay for them. And this regulates how you pay for them.

JOHNSON: The Obama administration says taxpayers are on the hook for $43 billion each year in medical bills, racked up by people who have no insurance. Weiner says that's more than enough to trigger the federal government's interest in regulating this economic activity. And the administration says if states don't like the new law, they can just opt out of federal insurance programs like Medicaid.

Mr. WEINER: Congress is appropriating billions of dollars that it's providing to the states for Medicaid, and it's entitled to attach conditions to the billions of dollars that it provides.

JOHNSON: The states say it's not so easy to walk away from Medicaid and there is no clear way to sever those ties, even if they wanted to. A judge will hear the arguments when both sides face off in court in Florida in September.

And while it's been five months since President Obama signed his top domestic priority into law, national polls suggest the political divide persists.

Robert Blendon studies health policy and politics at Harvard.

Mr. ROBERT BLENDON (Harvard University): It's very partisan divisions, where overwhelmingly Democrats like this bill, think it's one of the great things for the country, and overwhelmingly Republicans think this bill is a terrible mistake. And in fact the polls that asked about repeal show most Republicans favoring some sort of repeal or replace.

JOHNSON: The most contentious aspect of the law, the individual mandate, doesn't take effect until 2014. The future of health care, Blendon says, could be subject to plenty of political changes before then, like two congressional elections and a presidential race.

Carrie Johnson, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

Carrie Johnson is a justice correspondent for the Washington Desk.