Lawyers for the federal government scoff at such "far-fetched hypothetical statutes." They maintain the individual mandate to buy insurance lifts the burden taxpayers now shoulder in paying tens of billions of dollars annually for medical care of the uninsured.
They also argue that states opposing the mandate risk leaving the uninsured "on the street after a car accident," and that "would be far more draconian than the tax penalty that Congress enacted" for those who fail to buy health insurance.
More than two dozen provisions of the law took effect last year, including allowing dependents up to age 26 to remain on their parents' insurance, new free health screenings for Medicare beneficiaries, cutting the costs of drugs in the Medicare prescription drug coverage gap known as the doughnut hole, and a new 10 percent tax on indoor tanning services. Another 21 provisions are scheduled to go into effect this year.
Vinson's ruling in Florida threw the states into confusion, with some officials declaring the law dead and others saying they would continue to implement it. On March 3, the judge clarified that the law remained in effect, pending the appeal.
Dozens of challenges
Even as states have created task forces to implement major provisions — including how to establish insurance exchanges, step up insurance regulation and expand Medicaid — about 600 measures have been introduced in state legislatures around the country to limit, alter or oppose the law, according to the National Conference of State Legislators.
Dozens of legal challenges have been filed in the federal court system. U.S. district courts have overturned the law or part of it in two cases, ruled the law constitutional and dismissed six cases, dismissed eight cases for procedural issues, and dismissed but gave the parties the right to refile in one case, according to the Kaiser Family Foundation, which is tracking 26 cases. A decision is pending in nine cases.