Affordable Care Act: Litigation Resources
Julia Taylor
Section Head - ALD Section and Information Research Specialist
Eva M. Tarnay
Law Librarian
March 23, 2012
Congressional Research Service
7-5700
www.crs.gov
R42437
CRS Report for Congress
Pr
epared for Members and Committees of Congress
Affordable Care Act: Litigation Resources
Summary
In March 2010, Congress passed P.L. 111-148, the Patient Protection and Affordable Care Act of
2010 (PPACA), and amended it by passing P.L. 111-152, the Health Care and Education
Reconciliation Act of 2010 (HCERA). Subsequently, lawsuits were filed in multiple courts
challenging various aspects of the new law. Many of these cases were heard in the district courts
and a few were appealed to appellate courts. In November 2011, the Supreme Court granted three
petitions for certiorari in one of these cases and later scheduled oral arguments for March 26-28,
2012.
This report contains resources for retrieving background information and selected legal material
relevant to these cases. It also includes information on CRS experts and products to assist in
understanding the legal and policy issues related to the act. This report will be updated as needed.
Congressional Research Service
Affordable Care Act: Litigation Resources
Contents
Supreme Court Cases....................................................................................................................... 1
Department of Health and Human Services et al. v. Florida et al. ........................................... 1
Supreme Court .................................................................................................................... 1
Appeals Court (United States Court of Appeals for the Eleventh Circuit).......................... 2
District Court (Northern District of Florida)....................................................................... 2
National Federation of Independent Business et. al. v. Kathleen Sebelius et al........................ 2
Supreme Court .................................................................................................................... 2
Florida et al. v. Department of Health and Human Services et al. ........................................... 3
Supreme Court .................................................................................................................... 3
Other Supreme Court Petitions ........................................................................................................ 3
Thomas More Law Center et al. v. Barack H. Obama et al....................................................... 3
Supreme Court .................................................................................................................... 3
Appeals Court (United States Court of Appeals for the Sixth Circuit) ............................... 4
District Court (Eastern District of Michigan)...................................................................... 4
Virginia, ex rel. Kenneth T. Cuccinelli, II, v. Sebelius ............................................................... 4
Supreme Court .................................................................................................................... 4
Appeals Court (United States Court of Appeals for the Fourth Circuit) ............................. 4
District Court (Eastern District of Virginia)........................................................................ 4
Liberty University et al. v. Timothy F. Geithner et al................................................................. 5
Supreme Court .................................................................................................................... 5
Appeals Court (United States Court of Appeals for the Fourth Circuit) ............................. 5
District Court (Western District of Virginia)....................................................................... 5
Selected Federal Legal Resources ................................................................................................... 5
Constitution of the United States......................................................................................... 5
Statutes and U.S. Code ........................................................................................................ 6
Cases and Litigation............................................................................................................ 7
Glossary of Common Litigation Terms ........................................................................................... 8
Selected CRS Products .................................................................................................................... 8
Affordable Care Act Litigation.................................................................................................. 8
Affordable Care Act Policy Issues............................................................................................. 9
Contacts
Author Contact Information............................................................................................................. 9
CRS Legal, Policy, and Research Experts ....................................................................................... 9
Acknowledgment........................................................................................................................... 10
Congressional Research Service
Affordable Care Act: Litigation Resources
n March 2010, Congress passed P.L. 111-148, the Patient Protection and Affordable Care Act
of 2010 (PPACA) and amended it by passing P.L. 111-152, the Health Care and Education
I Reconciliation Act of 2010 (HCERA). Subsequently, lawsuits were filed in multiple courts
challenging various aspects of the new law. Many of these cases made their way through the
judicial system and three petitions for certiorari were ultimately granted by the United States
Supreme Court in one of these cases. This collection of resources is intended to assist in
responding to a broad range of research questions and requests for assistance related to the
Affordable Care Act litigation before the Supreme Court.
Supreme Court Cases
On November 14, 2011, the Supreme Court granted three petitions for certiorari to decide issues
raised by the Affordable Care Act cases: (1) National Federation of Independent Business v.
Sebelius, No. 11-393, (2) Florida v Department of Human Services, No. 11-400, and (3)
Department of Health and Human Services v. Florida, No. 11-398.1 Please note, the Court agreed
to hear four separate questions raised by the three petitions. Oral arguments for the cases are
scheduled to take place March 26-28, 2012.2 According to a press release issued on March 16,
2012, after each session the Court will provide audio recordings and transcripts of the oral
arguments through its website. 3
Below are links to documents related to these cases before the Court.4 Many of the documents are
available on the Supreme Court’s Patient Protection and Affordable Care Act website at
http://www.supremecourt.gov/docket/PPAACA.aspx. For further information from the Court, the
public information officer can be reached at (202) 479-3211.
Department of Health and Human Services et al. v. Florida et al.
The questions for the Court raised by this petition are whether Congress has the power under
Article I of the Constitution to enact the minimum coverage provision of PPACA and whether the
challenges to the minimum coverage provision itself are barred by the Anti-Injunction Act.
Supreme Court
• Docket No. 11-398
http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/11-398.htm
• Petition for a Writ of Certiorari
http://www.supremecourt.gov/docket/PDFs/11-398%20Cert%20Petititon.pdf
1 The order granting certiorari in the Affordable Care Act cases is available at http://www.supremecourt.gov/docket/
PDFs/111411zr.pdf.
2 The calendar for the Court for the session beginning March 19, 2012, is available at http://www.supremecourt.gov/
oral_arguments/argument_calendars/MonthlyArgumentCalMAR2012.pdf. The order allocating time is available on the
Supreme Court’s website at http://www.supremecourt.gov/docket/PDFs/022112zor.pdf.
3 See “Patient Protection and Affordable Care Act cases on March 26, 27, and 28, 2012” available at
http://www.supremecourt.gov/publicinfo/press/viewpressreleases.aspx?FileName=pr_03-16-12.html.
4 For information on other PPACA related cases, see the Department of Justice’s Defending the Affordable Care Act
website at http://www.justice.gov/healthcare/index.html.
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Affordable Care Act: Litigation Resources
• Appendix to Petition
http://www.supremecourt.gov/docket/PDFs/11-398%20appendix.pdf
• Brief of Private Respondents
http://www.supremecourt.gov/docket/PDFs/11-398%20BIO%20Private.pdf
• Brief of State Respondents
http://www.supremecourt.gov/docket/PDFs/11-398%20BIO%20States.pdf
• Reply Brief
http://www.supremecourt.gov/docket/PDFs/11-398%20Reply.pdf
Appeals Court (United States Court of Appeals for the Eleventh Circuit)
• Florida v. United States HHS, 648 F.3d 1235 (11th Cir. Fla. 2011)5
http://www.uscourts.gov/uscourts/courts/ca11/201111021.pdf
District Court (Northern District of Florida)
• Order Granting Summary Judgment, Florida v. United States HHS, 780 F. Supp.
2d 1256 (N.D. Fla. 2011) 6
http://www.justice.gov/healthcare/docs/fl-sj-ruling.pdf
National Federation of Independent Business et. al. v. Kathleen
Sebelius et al.
The questions for the Court in this petition concern the severability of the minimum coverage
provision from the rest of the Affordable Care Act if the minimum coverage provision is found to
be unconstitutional.
Supreme Court
• Docket No. 393
http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/11-393.htm
• Petition for Writ of Certiorari
http://www.supremecourt.gov/docket/PDFs/11-393%20Cert%20Petition.pdf
• Appendix to Petition
http://www.supremecourt.gov/docket/PDFs/11-393%20Appendix.pdf
• Brief in Opposition
http://www.supremecourt.gov/docket/PDFs/11-393%20BIO.pdf
5 Docket Nos. 11-11021 and 11-11067.
6 Docket No. 10-cv-91.
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Florida et al. v. Department of Health and Human Services et al.
The questions for the Court in this petition are limited to whether the individual mandate can be
severed from the act, and whether the changes to Medicaid in the Affordable Care Act
unconstitutionally coerce the states.
Supreme Court
• Docket No. 11-400
http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/11-400.htm
• Petition for Writ of Certiorari
http://www.supremecourt.gov/docket/PDFs/11-400%20Cert%20Petition.pdf
• Brief in Opposition
http://www.supremecourt.gov/docket/PDFs/11-400%20BIO.pdf
• Reply Brief
http://www.supremecourt.gov/docket/PDFs/11-400%20Reply.pdf
Other Supreme Court Petitions
In addition to the cases referenced above, information is provided on three other cases in which a
petition for a writ of certiorari has been filed and that contain notable legal arguments related to
the Affordable Care Act cases.
Thomas More Law Center et al. v. Barack H. Obama et al.
In this petition for certiorari, the petitioners present arguments on whether Congress had the
power under Article I of the Constitution to enact the minimum coverage provision of PPACA.
Supreme Court
• Docket No. 11-117
http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/11-117.htm
• Petition for Writ of Certiorari
http://www.supremecourt.gov/docket/PDFs/11-117%20Cert%20Petition.pdf
• Brief in Opposition
http://www.supremecourt.gov/docket/PDFs/11-117%20BIO.pdf
• Reply Brief
http://www.supremecourt.gov/docket/PDFs/11-117%20%20Reply.pdf
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Affordable Care Act: Litigation Resources
Appeals Court (United States Court of Appeals for the Sixth Circuit)
• Opinion, Thomas More Law Ctr. v. Obama, 651 F.3d 529 (6th Cir. Mich. 2011)7
http://www.ca6.uscourts.gov/opinions.pdf/11a0168p-06.pdf
District Court (Eastern District of Michigan)
• Order Denying Plaintiffs’ Motion for Injunction and Dismissing Plaintiffs’ First
and Second Claims for Relief [Doc #7], Thomas More Law Ctr. v. Obama, 720 F.
Supp. 2d 882 (E.D. Mich. 2010)8
http://www.mied.uscourts.gov/News/Docs/09714485866.pdf
Virginia, ex rel. Kenneth T. Cuccinelli, II, v. Sebelius
In this petition for certiorari, the petitioners present arguments on whether a state has standing to
challenge the minimum coverage provision, whether Congress had the power under Article I of
the Constitution to enact the minimum coverage provision, and whether the minimum coverage
provision is severable from the rest of the Affordable Care Act.
Supreme Court
• Docket No. 11-420
http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/11-420.htm
• Petition for Writ of Certiorari
http://www.supremecourt.gov/docket/PDFs/11-420%20Cert%20Petition.pdf
• Brief in Opposition
http://www.supremecourt.gov/docket/PDFs/11-420%20BIO.pdf
Appeals Court (United States Court of Appeals for the Fourth Circuit)
• Opinion, Virginia ex rel. Cuccinelli v. Sebelius, 656 F.3d 253 (4th Cir. Va. 2011)9
http://pacer.ca4.uscourts.gov/opinion.pdf/111057.P.pdf
District Court (Eastern District of Virginia)
• Memorandum Opinion (Cross Motions for Summary Judgment), Commonwealth
ex rel. Cuccinelli v. Sebelius, 728 F. Supp. 2d 768 (E.D. Va. 2010)10
http://www.justice.gov/healthcare/docs/cucinelli-v-sebelius-memo-opinion-
summary-judgment.pdf
7 Docket No. 10-2388.
8 Docket No. 10-cv-11156.
9 Docket Nos. 11-1057 and 11-1058.
10 Docket No. 10-cv-188.
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Affordable Care Act: Litigation Resources
Liberty University et al. v. Timothy F. Geithner et al.
In this petition for certiorari, the petitioners present arguments on whether the challenges to the
minimum coverage provision itself are barred by the Anti-Injunction Act and whether Congress
has the power under Article I of the Constitution to enact the minimum coverage provision of
PPACA.
Supreme Court
• Docket No. 11-438
http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/11-438.htm
• Petition for a Writ of Certiorari
http://www.supremecourt.gov/docket/PDFs/11-438%20Cert%20Petition.pdf
• Brief in Opposition
http://www.supremecourt.gov/docket/PDFs/11-438%20BIO.pdf
• Reply Brief
http://www.supremecourt.gov/docket/PDFs/11-438%20Reply.pdf
Appeals Court (United States Court of Appeals for the Fourth Circuit)
• Opinion, Liberty Univ., Inc. v. Geithner, 2011 U.S. App. LEXIS 18618, 2011 WL
3962915 (4th Cir. Va. 2011)11
http://www.justice.gov/healthcare/docs/liberty-university-4th-circuit-opinion.pdf
District Court (Western District of Virginia)
• Memorandum Opinion, Liberty Univ., Inc. v. Geithner, 753 F. Supp. 2d 611
(W.D. Va. 2010)12
http://www.vawd.uscourts.gov/OPINIONS/MOON/
LIBERTYUNIVERSITYVGEITHNER.PDF
Selected Federal Legal Resources
The following are selected links to statutes, laws, and cases that are relevant to the issues before
the Court.
Constitution of the United States
• The Constitution of the United States of America: Analysis and
Interpretation
http://crs.gov/analysis/Pages/constitutionannotated.aspx?source=QuickLinks
11 Docket No. 10-2347.
12 Docket No. 10-cv-15.
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Affordable Care Act: Litigation Resources
Also known as “The Constitution Annotated” or “CONAN”, this resource contains legal
analysis and interpretation of the United States Constitution, based primarily on Supreme
Court case law. It is especially useful when researching the constitutional implications of
a specific issue or topic. Some of the commonly referenced constitutional provisions
related to PPACA are below:
Constitution of the United States, Article I, Section 8, Clause 1. The “Power to Tax and
Spend Clause”
The Congress shall have Power to lay and collect Taxes, Duties, Imposts and Excises, to
pay the Debts and provide for the common Defence and general Welfare of the United
States; but all Duties, Imposts and Excises shall be uniform throughout the United States.
Constitution of the United States, Article I, Section 8, Clause 3. The “Commerce Clause”
The Congress shall have Power *** To regulate Commerce with foreign Nations, and
among the several States, and with the Indian Tribes.
Constitution of the United States, Article I, Section 8, Clause 18. The “Necessary and
Proper Clause”
The Congress shall have Power *** To make all Laws which shall be necessary and
proper for carrying into Execution the foregoing Powers, and all other Powers vested by
the Constitution in the Government of the United States, or in any Department or Officer
thereof.
Constitution of the United States, Article VI, Clause 2. The “Supremacy Clause”
This Constitution, and the Laws of the United States which shall be made in Pursuance
thereof; and all Treaties made, or which shall be made, under the Authority of the United
States, shall be the supreme Law of the Land; and the Judges in every State shall be
bound thereby; any Thing in the Constitution or Laws of any State to the Contrary
notwithstanding.
Statutes and U.S. Code
• Compilation of the Patient Protection and Affordable Care Act
http://housedocs.house.gov/energycommerce/ppacacon.pdf
Compiled by the Office of Legislative Counsel, this committee print contains the text of
P.L. 111-148, the Patient Protection and Affordable Care Act (PPACA) consolidated with
the amendments made by title X of P.L. 111-152, the Health Care and Education
Reconciliation Act of 2010 (HCERA). Links to the text of the codified version of two
particular PPACA provisions at issue in the litigation are provided below:
Maintenance of Minimum Essential Coverage, 26 U.S.C. § 5000A.
http://www.gpo.gov/fdsys/pkg/USCODE-2010-title26/pdf/USCODE-2010-
title26-subtitleD-chap48.pdf
Enacted and amended as part of the health care reform legislation, this section of PPACA
deals with minimum coverage.
• State Plans for Medical Assistance, 42 U.S.C. § 1396a
http://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-
title42-chap7-subchapXIX-sec1396a.pdf
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Affordable Care Act: Litigation Resources
PPACA amended existing laws related to the Medicaid program to require expanded
coverage.
• Anti-Injunction Act, 26 U.S.C. § 7421
http://www.gpo.gov/fdsys/pkg/USCODE-2010-title26/pdf/USCODE-2010-
title26-subtitleF-chap76-subchapB-sec7421.pdf
Enacted in 1954, this act prohibits a court from hearing a case to prevent the assessment
or collection of a tax (except in certain circumstances).
Cases and Litigation
Below are three cases often cited in the discussion of commerce clause issues.
• United States v. Lopez, 514 U.S. 549 (U.S. 1995)
http://www.supremecourt.gov/opinions/boundvolumes/514bv.pdf
In this Supreme Court case, a conviction under the Guns Free School Zone Act was
overturned. The Court held the act was beyond the power of Congress under the
commerce clause.
• United States v. Morrison, 529 U.S. 598 (U.S. 2000)
http://www.supremecourt.gov/opinions/boundvolumes/529bv.pdf
In this case, the Court held Congress lacked the authority to enact a statute because it did
not involve commercial activity.
• Gonzalez v. Raich, 545 U.S. 1 (U.S. 2005)
http://www.supremecourt.gov/opinions/boundvolumes/545bv.pdf
The Court examined whether Congress could prohibit the cultivation of marijuana for
personal, medicinal use, and held that such regulation was permissible under the
Commerce Clause because these activities, when viewed in the aggregate, had a
substantial effect on the interstate market for marijuana.
Below are two cases cited in the discussion of the expansion of Medicaid coverage.
• South Dakota v. Dole, 483 U.S. 203 (U.S. 1987)
http://www.law.cornell.edu/supremecourt/text/483/203
In this case, the Court held that the general welfare provision of the Taxing and Spending
Clause to the Constitution gave Congress the power to condition federal funds on a state’s
establishment of a minimum drinking age.
• Garcia v. San Antonio Metro. Transit Auth., 469 U.S. 528 (U.S. 1985)
http://www.law.cornell.edu/supremecourt/text/469/528
In this case, the Court held that a public mass transit authority entity was not entitled to
immunity from federal wage and overtime standards.
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Affordable Care Act: Litigation Resources
Glossary of Common Litigation Terms
In researching these cases, those less accustomed with court proceedings may encounter
unfamiliar terms. Below are definitions, taken from Black’s Law Dictionary, Ninth Edition, for
some common words used in litigation.
Brief
A written statement setting out the legal contentions of a party in litigation, esp.
on appeal; a document prepared by counsel as the basis for arguing a case,
consisting of legal and factual arguments and the authorities in support of them.
Amicus
brief
A brief, usually at the appellate level, prepared and filed by an amicus curiae with
the court’s permission. Sometimes shortened to amicus. Also termed friend-of-
the-court brief.
Appellate
brief
A brief submitted to an appeals court; specif., a brief filed by a party to an appeal
pending in a court exercising appellate jurisdiction.
Reply
brief
A brief that responds to issues and arguments raised in the brief previously filed
by one’s opponent; esp., a movant’s or appellant’s brief filed to rebut a brief in
opposition.
Certiorari Petition (or a Petition A formal written request presented to a court or other official body.
for a Writ of Certiorari)
Decision
A judicial or agency determination after consideration of the facts and the law;
esp., a ruling, order, or judgment pronounced by a court when considering or
disposing of a case.
Docket
A formal record in which a judge or court clerk briefly notes all the proceedings
and filings in a court case.
Petitioner
A party who presents a petition to a court or other official body, esp. when
seeking relief on appeal.
Respondent or Appellee
The party against whom an appeal is taken. In some appellate courts, the parties
are designated as petitioner and respondent. In most appellate courts in the
United States, the parties are designated as appellant and appellee.
Selected CRS Products
Listed below are existing CRS products on the Affordable Care Act litigation and related policy
issues. Additional titles are available on the CRS.gov website, http://www.crs.gov, by searching
or browsing the Health Care Issues Before Congress.
Affordable Care Act Litigation
CRS Report R40725, Requiring Individuals to Obtain Health Insurance: A Constitutional
Analysis, by Jennifer Staman et al.
CRS Report R40846, Health Care: Constitutional Rights and Legislative Powers, by Kathleen S.
Swendiman.
CRS Report R42367, Federalism Challenge to Medicaid Expansion Under the Affordable Care
Act: Florida v. Department of Health and Human Services, by Kenneth R. Thomas.
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Affordable Care Act: Litigation Resources
CRS Report RL34708, Religious Exemptions for Mandatory Health Care Programs: A Legal
Analysis, by Cynthia Brougher.
Affordable Care Act Policy Issues
CRS Report R41664, ACA: A Brief Overview of the Law, Implementation, and Legal Challenges,
coordinated by C. Stephen Redhead.
CRS Report R41331, Individual Mandate and Related Information Requirements under ACA, by
Janemarie Mulvey.
CRS Report R41159, Summary of Potential Employer Penalties Under the Patient Protection and
Affordable Care Act (PPACA), by Janemarie Mulvey.
CRS Report R41210, Medicaid and the State Children’s Health Insurance Program (CHIP)
Provisions in ACA: Summary and Timeline, by Evelyne P. Baumrucker et al.
CRS Report R42431, Upcoming Rules Pursuant to the Patient Protection and Affordable Care
Act: Fall 2011 Unified Agenda , by Maeve P. Carey and Michelle D. Christensen.
Author Contact Information
Julia Taylor
Eva M. Tarnay
Section Head - ALD Section and Information
Law Librarian
Research Specialist
etarnay@crs.loc.gov, 7-1414
jtaylor@crs.loc.gov, 7-5609
CRS Legal, Policy, and Research Experts
Area of Expertise
Name
Phone
E-mail
Legal Issues
Edward C. Liu
7-9166
eliu@crs.loc.gov
Erika K. Lunder
7-4538
elunder@crs.loc.gov
Jennifer
Staman
7-2610
jstaman@crs.loc.gov
Kenneth R. Thomas
7-5006
kthomas@crs.loc.gov
Kathleen S. Swendiman
7-9105
kswendiman@crs.loc.gov
Religious Exemptions Only
Cynthia Brougher
7-9121
cbrougher@crs.loc.gov
Court Documents Only
Julia Taylor
7-5609
jtaylor@crs.loc.gov
Policy Issues
Evelyne Baumrucker
7-8913
ebaumrucker@crs.loc.gov
Bernadette
Fernandez
7-0322
bfernandez@crs.loc.gov
C. Stephen Redhead
7-2261
credhead@crs.loc.gov
Annie L. Mach
7-7825
amach@crs.loc.gov
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Affordable Care Act: Litigation Resources
Area of Expertise
Name
Phone
E-mail
Janemarie
Mulvey
7-6928
jmulvey@crs.loc.gov
Acknowledgment
Stuart C. Carmody, Reference Assistant with the American Law Division Knowledge Service’s Group and
the Legislative Attorneys in the American Law Division provided research and analytical assistance.
Congressional Research Service
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