[Twenty-seven] states/state attorneys general file lawsuit on health care bill

[tu_holmes]

If ObamaCare is so great - why is everyone under the sun seeking to get out from under it? 

Because politically it is currently unpopular.

[Soul Crusher]

Because politically it is currently unpopular.

It has nothing to do with politics, and has everything to do with economic and mathmatical reality.  Obamacare has always been the equivalent of a nuke against the public.

ObamaCare is worse than a madoff scheme.   At least madoffs' scam was voluntary - this pofs is at the barrell of an IRS gun.   


   

[tonymctones]

Because politically it is currently unpopular.

if that was really the case then the administration wouldnt be handing out waivers left and right to get out of it...

If it was simply about politics obama would just refute their points which he isnt doing...

[Soul Crusher]

if that was really the case then the administration wouldnt be handing out waivers left and right to get out of it...

If it was simply about politics obama would just refute their points which he isnt doing...

He can't because the facts are that obamaCare is single handidly one of the worst laws and policies EVER to have been passed.

Sorry you Obama Dildos, face it - you were conned.   

But - thats' alright - he is the 1st black Prez - so its ok.   Either I am racist; his plan must be ok if people like me are against it; or its a worldwide conspiracy against Obama.  Anything he does is ok.  Shit - bush did bad shit, so why complain when Obama follows in the same foot steps?     

That must be it.   Because there really can be no honest and justified criticism of the plans and programs of the messiah.   We were told he was the most brilliant, smart, knowing, caring, seeing, all-being, and  educated president of all time.   so any critiques of his policies can't be based upon substanc, it has to be a CT or something like that.             

[tu_holmes]

if that was really the case then the administration wouldnt be handing out waivers left and right to get out of it...

If it was simply about politics obama would just refute their points which he isnt doing...

I have heard lots of people refute certain things... I heard a lot of people claim that the single payer system would be a problem, so hence we got the shitty healthcare overhaul we have.

It's always been political... We have what we have because politics and business didn't mix well, so more politics.

There's lots of "politics" in this bill and in the people against it.

I understand that healthcare costs...really... I get that... but so does every other thing in the government and you can't sit here and talk about the cost of the healthcare bill and not talk about the costs of all of the other crap.

Defense, Medicare, Social Security... the top 3 spends we have right?

The healthcare bill is not going to, nor will it bankrupt our country more than any of those 3 items.

[Soul Crusher]

What Health Reform Missed: The Doctor Shortage
By Elizabeth MacDonald

Health reform seeks to provide coverage for all Americans, adding to the system an estimated 30 million to 47 million, depending on how they are counted, who don’t have coverage today.

The demand side of the reform advocates' story goes like this: Health reform  will pay for itself because of a new mandate penalty slapped on those who refuse coverage. That will ensure a massive influx of new insurance entrants, including healthy strapping young people who don't have coverage today, which means more revenue for the insurance industry. (And more tax revenue because of new taxes, including a tax on medical device makers and an increase in Medicare payroll taxes on the upper bracket, but that's for another day).

But D.C. policymakers have missed one key and crucial point in their narrative. The United States is facing a growing shortage of doctors, say two of the country's biggest doctor groups, the American College of Physicians and the Association of American Medical Colleges. And the missing doctor-shortage supply side of DC’s argument is worse than realized.

Because of this looming doctor shortage, health reform essentially will create market forces that will enact rationing of care, as more insured individuals flood into a system that sees a dwindling number of doctors to care for them. Picking up where insurers left off when it comes to rationing.

This is rationing by supply constraint, because the government cannot ration by price, try as it might.

And that shortage in supply of doctors becomes even more crucial, as health reform seeks to stop the insurance industry’s insidious practice of knocking out people from coverage if they have pre-existing conditions, which most everyone applauds. The doctor shortage becomes exponentially more serious as 71 million baby boomers approach retirement age, and as the creaky Medicare program faces serious strains to deal with a host of new beneficiaries with chronic diseases and fewer doctors to treat them.

The American College of Physicians [ACP], the nation’s top group of doctors notes that a recent peer-reviewed study estimates that there will be a shortage of 35,000 to 44,000 primary care physicians for adults by 2025. It expects long lines and wait times down the road once reform is enacted.

Notably missing will be doctors in key specialties, in general internal medicine and family medicine — the specialties that provide primary care to most adult and adolescent patients, says ACP.

And ACP says in a statement that’s “even before the increased demand for health care services that will result from near universal coverage is taken into account.” Primary care physicians number about 352,900 in the U.S.

Already, the Association of American Medical Colleges says the country could face a shortage of as many as 150,000 doctors by 2025. The number of U.S. doctors now totals around 954,000.
The Association says about 45,000 more primary care doctors, who will face the brunt of the new health reform law, will be needed by 2020. It also projects a shortage of 33,100 doctors in specialties such as cardiology, oncology and emergency medicine by 2015.

Meanwhile, medical universities have seen a decline in the number of med school students signing up for family medicine courses, dropping more than 25% between 2002 and 2007, the Association says. Medicare pays about $9.1 billion annually to teaching hospitals in order to maintain residency programs and treatment of Medicare patients, but medical schools fear those subsidies could get cut back.

ACP says when it comes to doctor shortages, Massachusetts' attempt at a universal care model provides a case study of what can happen. There, “shortages of primary care physicians have led to long waits for appointments,” ACP says.

Moreover, ACP says “the demand for primary care in the United States is expected to grow at a rapid rate while the nation’s supply of primary care physicians for adults is dwindling and interest by U.S. medical school graduates in pursuing careers in primary care specialties is steadily declining.”

ACP says the shortage of primary care doctors presents a crisis situation. Primary care doctors provide more than half of “all ambulatory care visits, 80% of patient visits for hypertension, and 69% of visits for both chronic obstructive pulmonary disease and diabetes,” ACP says, “yet they comprise only one-third of the U.S. physician workforce.” It adds: “If current trends continue, fewer than one out of five physicians will be in an adult primary care specialty.”

ACP cites a way out. It says: a "new report by the Council on Graduate Medical Education recommends that compensation to primary care physicians be increased to 70 percent of the average payment for other physician specialties in order to train and retain a sufficient supply of primary care physicians." Question is, will that work? And will it be enough?

 Print     Close URL

http://www.foxbusiness.com/markets/2011/02/15/health-reform-missed-doctor-shortage/

[Soul Crusher]

Alaska governor says he won't enact federal health care law; says it would violate his oath
star tribune ^ | 2/17/11 | BECKY BOHRER

________________________ ________________________ __



JUNEAU, Alaska - Alaska Gov. Sean Parnell says he will not enact the federal health care overhaul after a judge in Florida struck down the law as unconstitutional.

Parnell considers that ruling the law of the land, barring implementation in the state. He said the state will pursue options of its own instead.

It's not completely clear what practical impact Parnell's unusual decision will have. Alaska has a state-run plan for residents previously denied coverage for pre-existing conditions. The law's main expansion is pending.


(Excerpt) Read more at startribune.com ...

[Soul Crusher]

WWWTTTFFF? ? ? ? ?

FFFF   UUUUU   BBBB   OOOOO   ! ! ! ! !   

 

________________________ ___________-


Feb 17, 6:17 PM EST


Obama admin. asks judge to clarify health ruling
 
 
 
 
 
PENSACOLA, Fla. (AP) -- The Justice Department is asking a federal judge in Florida to tell states that they must continue to enact the Obama administration's health care overhaul despite his ruling that the law is unconstitutional.

In a motion to clarify filed late Thursday, attorneys for the Obama administration asked U.S. District Judge Roger Vinson to make clear that states cannot ignore the new health care laws while his ruling is being appealed.

Vinson ruled on Jan. 31 that President Barack Obama's entire health care overhaul law is unconstitutional. The broad challenge seems certain to be resolved only by the Supreme Court.

The lawsuit was filed by Florida and 25 other states.

© 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Learn more about our Privacy Policy and Terms of Use.
 

[Soul Crusher]

The Looming Failure of Obamacare, Part 1: Information
Feb. 10 2011 - 5:22 pm | 1,207 views | 0 recommendations | 1 comment
By WARREN MEYER

http://blogs.forbes.com/warrenmeyer/2011/02/10/the-looming-failure-of-obamacare-part-1-information

________________________ ______




In order to protect the core of Obamacare, Congressional Democrats have recently begun to acquiesce to a few incremental changes to the legislation that fix some of the most egregious parts of the plan (e.g. the burdensome 1099 requirements).  The implicit message is that yes, the legislation was rushed and has some flaws, but these flaws can be fixed by targeted tweaks around the edges.

Today I will begin the first of a three-part series explaining several reasons why any health care law that relies on the fundamental assumptions of Obamacare is doomed to fail, even if crafted by the smartest people through the best process.  In this first installment, we will discuss information problems inherent in the law’s top-down approach.  In the second segment, we will cover incentives issues that will breed a myriad of unintended consequences.  In the final part, we will discuss the ever-powerful urge to rent-seeking among certain businesses that will likely turn Obamacare into the largest single corporate welfare program in the history of this country.

In this critique, I will (mostly) avoid any discussion of ethics or Constitutionality.  Rather, I want to focus on the economic and behavioral issues that will doom any such government health care program, irregardless of its intentions.

Information


The computer keyboard I am typing on right now costs about $55 on Amazon.com.  Is that a fair price?

At some level, the answer must be “yes.”  Why?  Because I bought it – simple as that.  No one was compelling me to buy this particular model, so if I thought the price too high or the features too skimpy, I would have just passed on the purchase.  If I desperately wanted or needed a keyboard, I might have bought one of literally hundreds of others for sale at Amazon, priced from a low of $1.49 (used) to a high of $2400 (I kid you not).  After shopping through the various options, I chose my keyboard as the best match, for me, of price and features.

For decades, this seemingly prosaic act of individual “shopping” has been steadily eroded in health care with the growth of third party payers, particularly Medicare.   How much did you pay for you last doctor visit?  Your last x-ray?  Your last blood test?  Believe it or not, it is still possible to price-shop medical care — I do it myself, because I have a high deductible health insurance plan under which I pay all but the most bankrupting bills out of pocket.  As an example, three x-rays last month of my son’s ankle would have been billed to my insurance company at over $100, but I asked for their cash price and they pulled a separate book from a hidden place under the counter and quoted me $35.  I got a 70+% discount merely for caring about the price.

But my health plan, which includes this seemingly positive incentive to shop, will soon be illegal as high-deductible insurance plans, as well as medical savings accounts, are effectively banned.  Under Obamacare, virtually all individual payments for medical products and services will cease — the government and a few large, highly regulated insurers will pay for nearly every visit, drug, or procedure.  The government will be making price-value trade-offs for our care, and they will be doing it incredibly imperfectly, because by eliminating individual shopping they have cut off a, excuse the pun, priceless source of information.

Recognize that the price discovery process is a two way street.  Sellers can propose whatever prices they like, based on their expectations, or even fantasies, about how they should be compensated for their efforts.  These prices mean nothing without the act of shopping, of consumers providing feedback on these prices, in effect voting with their pocketbook for the price-value combinations they personally find compelling.

But now with a single buyer (or one government buyer and a few government regulated insurance company buyers) the feedback loop of millions of customers testing and voting on prices and features goes away.  The government will be presented with prices that are the demand, or even the fantasy, of individual sellers.   Do they accept these rates, or set their own?  How can they know the rate is fair?

Many of those in power have convinced themselves that a group of smart enough people can figure this out, but they can’t.  It’s simply too complex.  Perhaps a two-year study might arrive at the perfect pricing level for a particular set of market facts  (I doubt it, but lets assume for a moment) – but we all know things change constantly.  A prefect price for oil today is likely wrong tomorrow.

That is why the Congress argues every year over the “doc fix,” which is essentially a price setting exercise for doctor’s time.  The question drags on inconclusively for years because there simply is no way for  some folks in Washington to gather in a room and set one price for all doctor visits.  Doctors vary individually in their productivity, their skills, and their compensation expectations.  Consumers differ in how they like and dislike certain doctors, and what they value in the visit.

Think back to the keyboard I bought.  The one I chose is pretty popular, so I assume some other people make keyboard trade-offs similar to mine.  But even so, the keyboard I chose has only a tiny fraction of the total market.  In other words, the vast majority of consumers made price-value-feature trade-offs differently than I do.

Given this range of preferences, how likely is it that a government panel will make price-value trade-offs the same way you might for yourself?  I might be happy when the government decides that keyboards should all be exactly like mine and sell for $55, but what about the other 97% of consumers who preferred something else?  One health care consumer may want a doctor to spend lots of time with her;  another, like myself, might pay extra to get in and out as fast as possible with a minimum of waiting and chit chat.  In this context, the hubris of setting single reimbursement rates is insane.

Consider the FDA, which bans drugs as untried or potentially not efficacious enough.  These blanket bans might make sense for a healthy person for whom the risk or cost of using unproven medication can be high, but what about a woman who is already dying of cancer?  What does it mean for her that a drug might be unsafe?  Again, don’t mistakenly label this as government incompetence of heartlessness.  Bureaucrats may indeed be incompetent or heartless, but even if they were angels with 200 IQ’s, the problem of centrally adjusting to 300 million different preferences is simply impossible.

And the cost of failure here is enormous.   The wrong government-set doctor pricing that is slightly too high can add tens of billions of dollars to the Federal deficit and substantially increase costs over a free-market alternative.  A doctor pricing that is slightly too low could drive tens of thousands of doctors out of the profession, leading to long waits and poor quality  (which not coincidentally are endemic to socialized medicine schemes in other countries).  And whatever the chosen price, consumer options are inevitably narrowed drastically.

Who would have thought all these problems result from banning the simple act of shopping?  Centralizing the payments for health care prevents price-value trade-offs from being made where they belong, by individuals themselves looking after their own money and health.

Of course, there are other problems that occur when a third party payer system is put in place.  Not only do we lose all the valuable information in the pricing system, but our incentives for how we consume are totally altered.  But that is our next installment.

[Soul Crusher]

The Looming Failure of Obamacare, Part 2: Incentives
Feb. 17 2011 - 6:58 pm | 787 views | 0 recommendations | 0 comments
By WARREN MEYER

Last week, I discussed information problems that were fundamental to third-party payer health care systems like Obamacare.  By eliminating the prosaic act of shopping, the government has cut themselves off from critical information about the preferences and tradeoffs made by three hundred million Americans.  As a result, any attempts to set pricing top-down are doomed to failure, as evidenced by the impossibility of implementing the “doc fix” to change Medicare reimbursement rates for doctors.

But eliminating shopping, or the process of individuals making price-value-feature tradeoffs in purchasing medical care, has more downsides than just making pricing impossible.  It also creates terrible incentives that have tended to push every single state health care system towards bankruptcy.

Incentives

In the late 1960s, as part of the Great Society program, the US government constructed huge government housing complexes, with the goal of guaranteeing that everyone, no matter how poor, would have access to housing.  By the turn of the century, most of these complexes had succumbed to the wrecking ball  – the era of large public housing complexes was over.

Why?  Well, there were a lot of reasons the program failed, but a big one was faulty incentives.  By getting free housing, recipients had no “skin in the game,” no ownership, no financial participation in their housing.  As a result, many treated their taxpayer-funded abodes with contempt.  Why not?  They weren’t paying for it.  And if the property was in good shape at the end of the lease, they didn’t get any extra money.

I often compare Obamacare to the great failed public housing projects by warning folks that government health care is going to be much worse.    With the housing projects, we taxpayers paid large sums of money but only a few actually had to live in the horrible government apartments — at least most of us were able to keep our own homes.  With Obamacare, it is going to cost us even more money, and we are all going to have to move, figuratively, into the projects.

If we are all forced to have the same, low deductible, first-dollar health plans, what incentive is one going to have to stay out of the health care system, even for something minor?  What is to stop you from going to the doctor every day because you are hypochondriacal, or you are lonely, or bored, or just because you want to save on buying your own subscription to Highlights Magazine?  The buffet will be open and everything will be essentially free – what’s to stop people from gorging themselves?

You might say that you are more responsible than that, and perhaps you are.  But think about this:  Twenty years ago we used to all complain about the 2 or 3 pieces of junk mail we might find a day in our mailbox.  That was when the each piece of mail cost real money to send.  Today, junk mail in the form of email is essentially free to send.  How many pieces of junk mail do you get today?  Even if you are not hitting the system up for free health care, you know someone else will be spamming the system, and eventually all of us as taxpayers will have to pay for it.

The only way to stop this behavior is for the government to create a department of “No” to head off this behavior — what Sarah Palin so famously called “Death Panels.”   I already discussed why this centralization of making price-value health care tradeoffs can never have the information it needs to work.  But another reason it is bound to fail is that politicians simply do not have the intestinal fortitude to say “no.”

It is a particular irony to me that perhaps the biggest source of disatisfaction with private insurance that likely drives support for Obamacare are the sometimes seemingly arbitrary decisions by private health insurers not to cover certain expenses.  But if Obamacare is to be anything but a financial disaster, the government is going to have to say “no” at least as frequently as private insurers.  I don’t think they are up to it.

In fact, the political pressure will be on the Administration to say “no” to voters, err consumers, less frequently, and then try to make up cost savings by beating on suppliers (doctors, drug-makers, device manufacturers) for larger discounts.  And here we face what is perhaps the biggest incentive problem of them all — what happens to the incentive for drug makers to seek new cures or for doctors even to keep practicing when the government inevitably tries to balance budget deficits on their backs?

While I suppose we would all like to believe that politicians would never threaten future life-saving innovation or our kids’ ability to find a medical professional to close a near term budget hole, can you actually deny the possibility looking at how Congress and the Administration are approaching the current budget mess?

Look around the world today — not one country with a government health care system pays drug reimbursement rates at a level that provides any incentive for new drug development.  In fact, almost all of the world’s health care R&D is paid for by Americans.  What happens when politicians, trying to close an exploding health care spending hole in the Federal budget, do exactly what every other country in the world has done and use their power to drive drug prices down to marginal cost?

In fact, to be confident that there will continue to be health care innovation in the future at all, one has to believe that the US Government will act completely differenlty in running its government health care system than does every other government in the world, despite the fact it will have the incentives to behave identically to all of them.  Is this a bet you feel good about?

Of course, there likely will be a few corporations and health care businesses that will be winners under Obamacare — those with the political muscle to get special treatment under the law.  Rent-seeking will be the topic of my third installment next week.

[Soul Crusher]

House bans funding for healthcare reform law, Planned Parenthood
The Hill ^ | 2/18/2011 | Julian Pecquet




The House on Friday voted largely along party lines to prohibit funding for the healthcare reform law and eliminate funding for family planning.

In a quick succession of two-minute votes, the House adopted three amendments to their stop-gap budget bill that eliminate healthcare reform funding through the end of the fiscal year. The House also approved, 240-185, an amendment barring federal Title X family planning grants that was aimed squarely at Planned Parenthood.


(Excerpt) Read more at thehill.com ...

[Dos Equis]

Obama Justice Department Appeals Judge's Health Care Ruling
Published April 03, 2011
Associated Press
 
ATLANTA -- The Obama administration has appealed a judge's ruling that found the federal overhaul of the health care system unconstitutional.

The Justice Department filed a 62-page motion Friday to the 11th Circuit Court of Appeals in Atlanta that said there's clear and well-established precedent that Congress acted within its authority in adopting the overhaul. It said Congress mad "detailed findings establishing a foundation" for exercising the authority.

Florida and 25 other states filed the lawsuit that said Congress exceeded its authority by requiring all citizens to purchase health insurance or face tax penalties. U.S. District Judge Roger Vinson agreed in a Jan. 31 ruling that said Obama's entire health care overhaul is unconstitutional. It is considered the most sweeping ruling against the health care law.

Some states, including Alaska, have cited the decision in refusing to cooperate with the health care law. But Vinson issued another ruling last week ordering states to continue implementing the law while the case makes its way through the courts.

Either way, the broad challenge seems certain to be resolved only by the Supreme Court. Two other U.S. district judges have previously upheld the law, both Democratic appointees to the federal bench.

Vinson's rulings have found that lawmakers do not have the power to penalize citizens for not doing something. But he has acknowledged that the 11th Circuit could disagree with him.

"It is likely that the Court of Appeals will also reach divergent results and that, as most court-watchers predict, the Supreme Court may eventually be split on this issue as well," he wrote in the March 3 ruling.

Other states that joined Florida in filing the lawsuit were: Alabama, Alaska, Arizona, Colorado, Georgia, Indiana, Idaho, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.

http://www.foxnews.com/politics/2011/04/03/obama-justice-department-appeals-judges-health-care-ruling/

[Soul Crusher]

1200 waivers bitches. 

[Soul Crusher]

Democrat in Missouri to Oppose Health Care Law
NY Times ^ | April 11, 2011 | A. G. SULZBERGER and KEVIN SACK


KANSAS CITY, Mo. — Missouri’s Democratic attorney general broke with his party on Monday and urged a federal judge to invalidate the central provision of the new health care law.

The filing of the court brief by Attorney General Chris Koster, a onetime Republican state legislator who switched to the Democratic Party in 2007, underscores the act’s political tenuousness in a critical Midwestern swing state.

Mr. Koster’s action followed months of pressure from state Republicans that he join attorneys general from other states who are challenging the constitutionality of the law.

Rather than join the litigation, however, Mr. Koster chose to file a “friend of the court” brief, or legal argument, in the Court of Appeals for the 11th Circuit in Atlanta, which is reviewing one of five challenges to the act that have moved into the midlevel appellate courts.

Three lower court judges have upheld the law, while two have ruled that its central provision — the requirement that most Americans obtain insurance — is unconstitutional.

The 11th Circuit is hearing a case filed in Pensacola, Fla., by Republican governors and attorneys general from 26 states. The federal district judge in that case, Roger Vinson, decreed that the entire health care act should be invalidated, but stayed his ruling until the Supreme Court...

--snip--

His central argument echoed those made by plaintiffs in a number of the lawsuits, but it was noteworthy coming from a Democrat. The only Democratic state official who has joined the litigation as a plaintiff, Attorney General Buddy Caldwell of Louisiana, switched to the Republican Party in February...

--snip--

Known as a Republican moderate, he became a Democrat just months before announcing his candidacy for attorney general, succeeding despite criticism of the move from both parties, including being pinned with the nickname “Koster the Imposter.”


(Excerpt) Read more at nytimes.com ...

[Dos Equis]

I think Obama's reelection prospects are already in serious jeopardy, and if Obamacare is ruled unconstitutional by the supreme court then his single best "accomplishment" as president will have fizzled.  He'll definitely be done. 

[Soul Crusher]

GOVERNOR’S EXECUTIVE ORDER PROHIBITS STATE AGENCIES FROM IMPLEMENTING OBAMACARE
Idaho Governors Office ^ | April 20. 2011 | Mark Warbis



C.L. “Butch” Otter
GOVERNOR


NEWS RELEASE


FOR IMMEDIATE RELEASE: CONTACT: Jon Hanian
April 20, 2011 (208) 334-2100
11:028


GOVERNOR’S EXECUTIVE ORDER PROHIBITS STATE AGENCIES FROM IMPLEMENTING OBAMACARE


(BOISE) – Governor C.L. “Butch” Otter issued an executive order today imposing a State prohibition on receiving federal funding for or otherwise implementing the federal Patient Protection and Affordable Care Act – often called “Obamacare.”


Executive Order 2011-03 uses portions of House Bill 298, a so-called “nullification bill” that was approved by the Legislature this year. The executive order directs State agencies not to establish new programs, promulgate rules or accept federal funding to implement Obamacare. It also bars State agencies from assisting federal agencies in implementing the law.


A copy of the executive order can be found here.


“The Legislature clearly wanted to send a message to the national government this session, expressing its frustration with Obamacare. I agree with the message and know the debate about Obamacare would be vastly different, if not completely unnecessary, if the national government adhered to the Tenth Amendment,” Governor Otter wrote in a three-page letter to Secretary of State Ben Ysursa, explaining his veto of House Bill 298, which sought to entirely “nullify” the federal law’s application in Idaho.


“I also agree with the Legislature and the sponsors of this bill that now is not the time to implement Obamacare. However, it is equally unacceptable to forego exploring viable state solutions to our healthcare needs and allowing the national government to assert more control over Idahoans,” the Governor wrote. A copy of his letter can be found here.


While Executive Order 2011-03 bars State agencies from implementing Obamacare, it does allow the Idaho departments of Insurance and Health and Welfare to continue developing a State health insurance exchange. The Governor said that would prevent the federal government from controlling the state’s insurance market by administering an exchange of its own in Idaho.


“I had worked in the health insurance field for over 30 years and applaud the Governor for allowing Idaho to remain in control and giving our citizens the reins for our own solution to healthcare reform,” Idaho Department of Health and Welfare Director Richard Armstrong said. “I am confident that Idaho’s expertise and can-do attitude will design an exchange that provides better access for families and employers, while also preserving the health insurance marketplace.”


Wayne Hoffman, executive director of the Idaho Freedom Foundation – which worked closely with legislative sponsors of House Bill 298 – said the executive order was a positive alternative.


“When we started the year, our No. 1 priority was to stop the operability of Obamacare in Idaho. The Governor’s executive order meets our objectives by using our language from House bills 117 and 298 to send a powerful message that the State of Idaho will not be a willing partner in the implementation of an unconstitutional federal law,” Hoffman said. “It is an important step in the right direction for Idaho and for freedom. We are grateful to the Governor for his action as well as the hard work of Senators Pearce, Fulcher, Vick and Nuxoll, and Representatives Barbieri and Boyle, on this issue.”


Senator Russ Fulcher of Meridian, one of the Senate cosponsors, also welcomed Governor Otter’s action.


“The intent of H298 was to lawfully discourage the implementation of Obamacare in Idaho,” he said. “To me it doesn’t matter if that happens through legislation or executive order. I am just thankful to have the Governor’s support on the issue.”

[Dos Equis]

Appellate court set for health care review
By Bill Mears, CNN
May 9, 2011

(CNN) -- A federal court in Richmond, Virginia, is scheduled to conduct the nation's first appellate review of President Barack Obama's health care overhaul Tuesday, giving the controversial legislation a major legal test.

Federal judges across the country have been divided over the constitutionality of the law's "individual mandate" requiring most Americans to buy health insurance by 2014 or face financial penalties.

The law also mandates the expansion of Medicaid, the low-income health care program administered by the states.

The Supreme Court could be asked to take formal jurisdiction of one or more health care appeal by this fall and perhaps decide the matter by 2012, a presidential election year.

The three-judge appeals panel will hear two cases Tuesday, one filed by the state of Virginia and the other by private Liberty University, a Christian evangelical institution.

The Liberty University plaintiffs, among other things, contend the law would allow taxpayer dollars to fund abortions, a claim the Obama administration rejects.

Virginia state officials argue the Constitution's Commerce Clause does not give government the authority to force Americans to purchase a commercial product, like health insurance, that they may not want or need. The state equates such a requirement to a burdensome regulation of "inactivity."

Virginia is one of the few states in the country with a specific law saying residents cannot be forced to buy insurance.

The Justice Department counters that since every American will need medical care at some point in their lives, individuals do not "choose" to participate in the health care market. Federal officials have cited 2008 figures of $43 billion in uncompensated costs from the millions of uninsured people who receive health services -- costs which are shifted to insurance companies and are passed on to consumers.

Appeals courts in Atlanta and Cincinnati are set to tackle the divisive issue next month.

http://www.cnn.com/2011/POLITICS/05/09/health.care.courts/index.html

[Dos Equis]

This could really be the nail in the coffin for Obama and Congressional Democrats.  If his signature, partisan piece of legislation is deemed unconstitutional on the eve of the election, he's toast. 

Virginia AG Cuccinelli: Supreme Court Will Rule on Obamacare Before Elections
Tuesday, 10 May 2011 06:02 PM
By David A. Patten

The Supreme Court’s review of the constitutionality of President Barack Obama’s signature healthcare initiative is on a collision course with the 2012 election calendar.

Virginia Attorney General Ken Cuccinelli, speaking to the media after a hearing in Richmond, Va., on the latest legal challenge to the Patient Protection and Affordable Care Act, says the “most likely” target date for a Supreme Court ruling is June of 2012 — the precise point when the presidential race shifts into high gear.

“It will be teed up right when the fall of 2012 rolls around,” Cuccinelli said. “So the timing is kind of extraordinary — but not of our own making.”

One indication of the national significance of the ongoing legal challenges to Obamacare: Tea party protesters held a “Hands Off My Healthcare Rally” outside the U.S. 4th Circuit Court of Appeals, where Cuccinelli and federal attorneys fielded questions from a three-judge panel looking into whether the individual mandate — the requirement that citizens either purchase insurance or pay a penalty — exceeds the federal government’s enumerated powers under the Constitution.

Some legal scholars had predicted the case would not reach the Supreme Court until 2013. And Cuccinelli received a setback last month when the Supreme Court announced it would wait for the case to work its way through the appellate courts before beginning deliberations.

The various lawsuits filed against the federal government have progressed rapidly, however. Cuccinelli concedes federal attorneys could delay the appellate process. But he doubts it could stall the plethora of lawsuits now aiming to block Obamacare.

“It’s only partially within their control . . . they can try to delay it somewhat in some cases, but the last count I knew of there were 31 cases running across the country, all at various points. By June 8, four of them will have been argued at the circuit court level, and the 2010 [Supreme Court] term isn’t even over yet,” Cuccinelli said.

“It strikes me as not terribly likely that this will get past the 2011-2012 term of the Supreme Court. It’s possible, but the odds are in favor of the next term,” he added.

If the Supreme Court were to void key provisions of the president’s primary legislative accomplishment during the heart of the 2012 election season, it would toss a serious monkey wrench into the president’s re-election campaign.

Cuccinelli credited the healthcare debate with having an “enormous, enormous” political impact on the midterms, which led to the broadest GOP landslide in nearly 70 years.

“It remains to be seen how big an impact it will have in 2012,” he added. “But it’s hard to imagine that the president, for whom this is the crowning achievement legislatively so far, wouldn’t see it have a great impact one way or the other.”

Cuccinelli’s remarks followed oral arguments presented Tuesday to the three-judge panel on the Fourth Circuit court. There are 13 judges on Virginia’s 4th U.S. Circuit Court of Appeals. Eight are Democratic appointees, and five are Republican appointees. The three judges assigned to hear Virginia’s lawsuit at the appellate level were determined by random computer selection.

The luck of the draw wasn’t in Cuccinelli’s favor Tuesday. President Obama appointed two of the three judges assigned to hear the appeal. The third was appointed by former President Bill Clinton.

That didn’t appear to faze Cuccinelli, however. He knows the various lawsuits against Obamacare are headed for a Supreme Court review anyway.

“We really play with the cards we’re dealt, and make the best case we can,” he said. “These chips will fall where they may, and then we’ll be off to the Supreme Court.”

Cuccinelli expects the 4th Circuit Court to render its verdict on the case by June.

The appeal stems from a December 2010 ruling by U.S. District Judge Henry E. Hudson that Obamacare’s requirement that individuals must purchase healthcare “exceeds the constitutional boundaries of congressional power.”

In throwing out the individual mandate, Hudson allowed implementation of other aspects of healthcare reform to continue.

Cuccinelli wants the entire Affordable Care Act nixed, however, because the legislation lacked a severability clause, or language that specifies the remainder of the bill will take effect even if one part of it is struck down.

Federal attorneys, on the other hand, want the three-judge panel to throw out Cuccinelli’s lawsuit altogether, on the grounds that the state lacks the legal standing to challenge a federal law. Cuccinelli agrees that usually would be true. But when a law is unconstitutional, the supremacy of the federal government in law making no longer holds, he said.

The 4th Circuit panel also heard arguments Tuesday in a separate appeal related to Obamacare, brought by Liberty University.

In November 2010, U.S. District Judge Norman Moon dismissed Liberty University‘s legal challenge to Obamacare.

Moon ruled that not purchasing healthcare insurance represented an economic choice, and therefore could be regulated under the Commerce Clause of the constitution.

Cuccinelli said it was obvious from the judges’ questions Tuesday that they “struggled with the unprecedented nature” of the government’s argument that it has the right to regulate commerce — the purchase of insurance — that is not actually taking place.

Article 1, Section 8, Clause 3 of the U.S. Constitution states that Congress shall “regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.”

If the government had power to enact regulations forcing citizens to engage in economic activity, its authority would be “virtually unlimited,” said Cuccinelli.

“What we are fighting for is the system of limited government established by our Founding Fathers . . . even the president and the Congress must operate within the restrictions placed on them by the Constitution,” Cuccinelli said.

In January, another federal judge, Roger Vinson, issued a ruling in a Florida lawsuit that was joined by 25 other states.

Vinson declared that ObamaCare was unconstitutional, and struck down the entire law.

The Justice Department has appealed that ruling to the 11th Circuit Court, which is expected to rule on the case in June.

http://www.newsmax.com/Headline/supreme-court-obama-health/2011/05/10/id/395892

[Dos Equis]

Groups Target Thomas' Wife's Work to Force Him to Sit Out High Court Rulings on Health Care
Published May 30, 2011
FoxNews.com

Eyeing a potential 5-4 decision on President Obama's Affordable Care health care reforms, some Democratic lawmakers are trying to pressure Justice Clarence Thomas to sit out any health care case that may come before the Supreme Court.

And in an added tack to influence the court's decision-making, one election watchdog has demanded an FBI probe of the justice over a 2010 campaign finance ruling.

The months-long efforts to target Thomas focus on his financial disclosure forms, of which amended versions were filed earlier this month and released publicly on Friday. In them, Thomas reveals that his wife, Ginni Thomas, received a salary in 2010 from Liberty Central, a group that she helped found and which supports the repeal of the health care law.

"We knew that Justice Thomas' family had a financial stake in opposing health care reform. Now we know even more," Rep. Anthony Weiner (D-N.Y.) said in a statement. "It's pretty clear the justice has one option here: recusal."

Ginni Thomas announced last fall that she was leaving Liberty Central, less than a year after its creation, to join Liberty Consulting. According to IRS documents released by Liberty Central, she earned $150,000 from the organization in 2010.

Thomas has also earned income from Hillsdale College and the Heritage Foundation, the latter being proof enough, Weiner argued, that the justice is unable to participate in the eventual cases to reach the court.

Defenders of Justice Thomas note that nothing in the ethics rules compels Thomas to report the sums his wife earned on his financial disclosures. They add that it's no secret where Ginni Thomas worked.

Supporters of Thomas also say the effort to remove the justice from the court is an attempt to extract rulings -- 4-4 decisions at the high court leave appellate court decisions in place -- that they may not otherwise get on a divided court.

"If there's anyone who needs to recuse themselves from the health care cases it's Elena Kagan," said Carrie Severino, chief counsel and policy director for the Judicial Crisis Network

Severino, a former clerk to Thomas, told FoxNews.com that the only "reasonable explanation" for the recent attacks on Thomas is fear that Justice Elena Kagan, former solicitor general for the Obama administration, is going to have to recuse herself from future health care cases before the court.

"I'm not sure she will need to recuse herself, either, but there's a lot of questions out there," she added. "Already we've seen that she was involved at a supervisory level with strategizing to defend this law."

Severino said just because a spouse has an opinion -- or even earns a living off a position that may be debated before the court -- doesn't mean a jurist loses impartiality. If Mrs. Thomas had filed a case or brief in the issue, or was involved in the case, that'd be one thing, Severino said. But that's not the case here.

"All of them have spouses and opinions. There has to be a rational stopping point for this kind of effort," she said.

At the same time that Democrats go after Thomas for his wife's interests, another group is using those same disclosure forms to argue that the justice should be investigated by the FBI.

ProtectOurElections.org, run by Kevin Zeese, argued in a letter sent last week to the FBI that Thomas deliberately excluded his wife's income over the past 20 years and "engaged in judicial corruption" by receiving $100,000 in support from Citizens United during his nomination in 1991.

The group alleges that Thomas then paid up on a quid pro quo 19 years later when the court voted in favor of Citizens United in a campaign finance ruling that enables corporations and unions to donate to candidates without naming its contributors.

"The Citizens United decision has a major impact on elections by allowing unlimited funding by corporations, and the Citizens United Foundation financial support shows a conflict of interest for Justice Thomas in a 5-4 decision," Zeese told FoxNews.com.

But Severino said that such an in-kind donation "is so absurd it's hard to even respond to such an exaggerated allegation."

"They are about 20 years too late," she said. "Frankly, most of these (charges) are so far-fetched that they almost don't merit a response."

ProtectOurElections.org also alleges that Thomas "conspired with his wife in a form of 'judicial insider trading' by providing her with information about the result of the court's decision in Citizens United prior to its issuance, which she then used to launch a new company to take financial advantage of that decision to benefit her and her husband."

http://www.foxnews.com/politics/2011/05/30/groups-target-thomas-wife-seek-ouster-high-court-rulings/

[Dos Equis]

The nerve.   


Obama solicitor general: If you don't like mandate, earn less money
Share Print By: Philip Klein 06/02/11
Senior editorial writer Follow Him @Philipaklein

President Obama's solicitor general, defending the national health care law on Wednesday, told a federal appeals court that Americans who didn't like the individual mandate could always avoid it by choosing to earn less money.

Neal Kumar Katyal, the acting solicitor general, made the argument under questioning before the U.S. Court of Appeals for the Sixth Circuit in Cincinnati, which was considering an appeal by the Thomas More Law Center. (Listen to oral arguments here.)  The three-judge panel, which was comprised of two Republican-appointed judges and a Democratic-appointed judge, expressed more skepticism about the government's defense of the health care law than the Fourth Circuit panel that heard the Virginia-based Obamacare challenge last month in Richmond. The Fourth Circuit panel was made up entirely of Democrats, and two of the judges were appointed by Obama himself.

During the Sixth Circuit arguments, Judge Jeffrey Sutton, who was nominated by President George W. Bush, asked Kaytal if he could name one Supreme Court case which considered the same question as the one posed by the mandate, in which Congress used the Commerce Clause of the U.S. Constitution as a tool to compel action.

Kaytal conceded that the Supreme Court had “never been confronted directly” with the question, but cited the Heart of Atlanta Motel case as a relevant example. In that landmark 1964 civil rights case, the Court ruled that Congress could use its Commerce Clause power to bar discrimination by private businesses such as hotels and restaurants.

“They’re in the business,” Sutton pushed back. “They’re told if you’re going to be in the business, this is what you have to do. In response to that law, they could have said, ‘We now exit the business.’ Individuals don’t have that option.”

Kaytal responded by noting that the there's a provision in the health care law that allows people to avoid the mandate.

“If we’re going to play that game, I think that game can be played here as well, because after all, the minimum coverage provision only kicks in after people have earned a minimum amount of income,” Kaytal said. “So it’s a penalty on earning a certain amount of income and self insuring. It’s not just on self insuring on its own. So I guess one could say, just as the restaurant owner could depart the market in Heart of Atlanta Motel, someone doesn’t need to earn that much income. I think both are kind of fanciful and I think get at…”

Sutton interjected, “That wasn’t in a single speech given in Congress about this...the idea that the solution if you don’t like it is make a little less money.”

The so-called “hardship exemption” in the health care law is limited, and only applies to people who cannot obtain insurance for less than 8 percent of their income. So earning less isn't necessarily a solution, because it could then qualify the person for government-subsidized insurance which could make their contribution to premiums fall below the 8 percent threshold.

Throughout the oral arguments, Kaytal struggled to respond to the panel's concerns about what the limits of Congressional power would be if the courts ruled that they have the ability under the Commerce Clause to force individuals to purchase something.

Sutton said it would it be “hard to see this limit” in Congressional power if the mandate is upheld, and he honed in on the word “regulate” in the Commerce clause, explaining that the word implies you're in a market. “You don’t put them in the market to regulate them,” he said.

In arguments before the Fourth Circuit last month, Kaytal also struggled with a judge's question about what to do with the word “regulate,” to the point where the judge asked him to sit down to come up with an answer. (More on that exchange here). Kaytal has fallen back on the Necessary and Proper clause, insisting that it gives broader leeway to Congress.

Judge James Graham, a Reagan district court appointee who is temporarily hearing cases on the appeals court, said, “I hear your arguments about the power of Congress under the Commerce Clause, and I’m having difficulty seeing how there is any limit to the power as you’re defining it.”

Kaytal responded by referencing United States v. Morrison, in which the Supreme Court struck down parts of the Violence Against Women Act, and United States v. Lopez, which struck down gun free school zones. In those cases, Kaytal responded, the Supreme Court set the limit that the Commerce Clause had to regulate economic activities.

The health care market is unique, Kaytal insisted, because everybody will eventually participate. With the mandate, Kaytal said, “What Congress is regulating is not the failure to buy something. But failure to secure financing for something everyone is going to buy.”

Graham acknowledged Kaytal's arguments, yet reiterated that he was “having trouble seeing the limits.”

The problem with the “health care is unique” argument – and this is me talking – is that it just creates an opening for future Congresses to regulate all sorts of things by either a) arguing that a particular market is also special or b) finding a way to tie a given regulation to health care.

For instance, the example that's come up often is the idea of a law in which government forces individuals to eat broccoli.

During the Sixth Circuit argument, Kaytal said that such an example doesn't apply, because if you show up at a grocery store, nobody has to give you broccoli, whereas that is the case with health care and hospital emergency rooms.

Yet that argument assumes that Congress passes such a law as a regulation of the food market. What if the law was made as part of a regulation of the health care market? It isn't difficult to see where that argument can go.

The broccoli example is really a proxy for a broader argument about whether the government can compel individuals to engage in healthy behavior – it could just as well be eating salad, or exercising. There's no doubt that a huge driver of our nation's health care costs are illnesses linked to bad behavior. People who are overweight and out of shape cost more because they have increased risk of heart disease, diabetes, and so on. Those increased costs get passed on to all of us, because government pays for nearly half of the nation's health care expenses, a number that's set to grow under the new health care law. Is it really unrealistic to believe that future Congresses, looking for ways to control health care costs, could compel healthy behavior in some way? More pertinently, is there any reason why that would be unconstiutional under the precedent that would be set if the individual mandate is upheld?

With most experts expecting the case to go before the Supreme Court, it seems the biggest obstacle for the Obama administration is figuring out where power would be limited if the mandate were upheld. Those challenging the law have made a clear and understandable limit by drawing a distinction between regulating activity and regulating inactivity (i.e. the decision not to purchase insurance). But simply saying the health care market is unique doesn't actually create a very clear or understandable limit to Congressional power.

The 11th Circuit hears the case next week brought by 26 states led by Florida.


http://washingtonexaminer.com/blogs/beltway-confidential/2011/06/obama-solicitor-general-if-you-dont-mandate-earn-less-money

[Soul Crusher]

Typical of this disgusting admn. 

[Soul Crusher]

Court Grills Government on Obamacare 'Mandate'
http://www.sunshinestatenews.com/story/court-grills-government-obamacare-mandate ^ | June 8, 2011 | Kenric Ward |

Posted on Wednesday, June 08, 2011 6:05:30 PM by sheikdetailfeather

A business plaintiff in the legal challenge to Obamacare said opponents had "a good day" at the 11th Circuit Court of Appeal on Wednesday.

Presiding over a packed courtroom in Atlanta, a three-judge panel heard oral arguments from both sides over the constitutionality of the Affordable Care Act.

A coalition of 26 states, led by Florida and the National Federation of Independent Business, argued that the ACA's mandate requiring the purchase of health insurance was an unprecedented overreach of federal power.

Attorneys for the U.S. Justice Department countered that the program is constitutional, but they ran into skeptical inquiries from the panel.


(Excerpt) Read more at sunshinestatenews.com ...

[Soul Crusher]

US judges seem receptive to health care challenge

AP – Mike Griffith, of Canton, Ga., holds a sign during a protest against President Barack Obama's health …
By GREG BLUESTEIN, Associated Press Greg Bluestein, Associated Press – 17 mins ago




ATLANTA – Judges on a federal appeals court panel on Wednesday repeatedly raised questions about President Barack Obama's health care overhaul, expressing unease with the requirement that virtually all Americans carry health insurance or face penalties.


All three judges on the 11th Circuit Court of Appeals panel questioned whether upholding the landmark law could open the door to Congress adopting other sweeping economic mandates.

The Atlanta panel did not immediately rule on the lawsuit brought by 26 states, a coalition of small businesses and private individuals who urged the three to side with a federal judge in Florida who struck down the law.

But the pointed questions about the so-called individual mandate during almost three hours of oral arguments suggests the appeals court panel is considering whether to rule against at least part of the federal law to expand health care coverage to tens of millions of Americans.

Federal appeals courts in Cincinnati and Richmond have both heard similar legal constitutional challenges to the law within the last month, and lawyers on both sides agree the case is headed for the U.S. Supreme Court.

At issue Wednesday was a ruling by U.S. District Judge Roger Vinson of Florida to invalidate the entire law, from the Medicare expansion to a change that allows adult children up to age 26 to remain on their parents' insurance. The government contends that the law falls within its powers to regulate interstate commerce.

Chief Judge Joel Dubina, who was tapped by Republican President George H.W. Bush, struck early by asking the government's attorney "if we uphold the individual mandate in this case, are there any limits on Congressional power?" Circuit Judges Frank Hull and Stanley Marcus, who were tapped by Democratic President Bill Clinton, echoed his concerns later in the hearing.

Acting U.S. Solicitor Neal Katyal sought to ease their concerns by saying the legislative branch can only exercise its powers to regulate commerce if it will have a substantial effect on the economy and solve a national, not local, problem. Health care coverage, he said, is unique because of the billions of dollars shifted in the economy when Americans without coverage seek medical care.

"That's what stops the slippery slope," he said.

Paul Clement, a former U.S. solicitor representing the states, countered that the federal government should not have the power to compel residents to buy to engage in commercial transactions. "This is the case that crosses the line," he said.

Hull also seemed skeptical about the government's claim that the mandate was crucial to covering most of the 50 million or so uninsured Americans. She said the rolls of the uninsured could be pared significantly through other parts of the package, including expanded Medicare discounts for some seniors and a change that makes it easier for those with pre-existing medical conditions to get coverage. Dubina nodded as she spoke.

The appeals court panel, which did not indicate when it would rule, has several options. But Hull and Dubina asked the lawyers on both sides to focus on a particular outcome: What could happen to the overhaul, they asked separately, if the individual mandate were invalidated but the rest of the package were upheld?

Parts of the overall law should still survive, said government lawyer Katyal, but he warned the judges they'd make a "deep, deep mistake" if the insurance requirement were found to be unconstitutional. He said Congress had the right to regulate what uninsured Americans must buy because they shift $43 billion each year in medical costs to other taxpayers.

Clement, however, argued that the insurance requirement is the "driving force" of the broader package, which he said violates the Constitution's legitimate authority. Without it, he said, the rest of the package should collapse.

"If you take out the hub, the spokes will fall," Clement said.

Marcus, meanwhile, said the case struck him as an argument over individual liberties, but questioned whether the judicial branch should "stop at the water's edge" or intervene.

So far, three Democratic-appointed federal judges have upheld the health care law and two Republican-appointed judges, including Vinson, have ruled against it.

Wednesday's arguments unfolded in what's considered one of the nation's most conservative appeals courts. But the randomly selected panel represents different judicial perspectives. None of the three are considered either stalwart conservatives or unfailing liberals.

Dubina, who came to the bench as a federal magistrate in 1983, is not considered to be as reflexively conservative as some of his colleagues. But he's under particular scrutiny because of his daughter's outspoken opposition to the health care overhaul. U.S. Rep. Martha Dubina Roby, a Montgomery, Ala., Republican elected in November, voted to repeal the health care ban because she said it was "less about providing health care for all citizens, and more about expanding federal government."

Marcus was nominated by Republican President Ronald Reagan to serve on the Florida bench after several years as Miami's lead federal prosecutor; he was later elevated by Clinton. And Hull, a former county judge in Atlanta, is known for subjecting both sides of the counsel table with challenging questions.

A crush of people gathered outside the 11th Circuit nearly three hours before the arguments were held to guarantee a spot, and the court opened an adjoining courtroom for the spillover crowd. The cramped room was packed with high-profile attorneys and politicians, including Georgia Attorney General Sam Olens, who sat in the front row. In a rare move, the court decided to sell $26 audiotapes of the arguments for those who missed out.

As the arguments took place, about 75 people staged a rally outside the downtown Atlanta building urging the appeals court to strike the law down, waving signs including one that read "Hands Off My Health Care."

___

Bluestein can be reached at http://www.twitter.com/bluestein





________________________ __________________-


Hoax & Chains   

[Dos Equis]

Hoax & Chains   

lol   

[Soul Crusher]

Healthcare overhaul fight in pivotal Atlanta court
By The Associated Press
http://www2.alabamas13.com/news/2011/jun/08/3/healthcare-overhaul-fight-pivotal-atlanta-court-ar-1944861



ATLANTA (AP) - The latest round in the fight over President Barack Obama's health care overhaul was held Wednesday in the federal appeals court in Atlanta.

A three-judge panel of the 11th Circuit Court of Appeals heard oral arguments on whether to reverse a Florida judge's ruling that struck down the law. The judges seemed receptive to arguments from critics challenging the health reforms as unconstitutional during the three-hour hearing.


Some 26 states opposing the law and an alliance of small businesses argue that Congress didn't have the power to require virtually all Americans to maintain health insurance. The Justice Department says the legislative branch exercised its "quintessential" right.

A three-judge federal appeals court panel in Cincinnati heard arguments last week about whether the law's mandate to buy health insurance went beyond congressional authority, and a federal appeals court based in Richmond, Va. heard oral arguments May 10 in another legal challenge to the law.

Lawyers on both sides have said the cases ultimately will be decided by the U.S. Supreme Court. But the appeal court panel's decision in Atlanta is being closely watched and could help shape the debate.

There's considerable legal firepower on both sides of the argument. Former U.S. Solicitor Paul Clement represents the challenging states and current U.S. Solicitor Neal Katyal will speak for the government.

It unfolded in what's considered one of the nation's most conservative appeals courts. But the randomly selected panel includes two appointees of Democratic President Bill Clinton, and observers say it's hard to predict how they'll decide. The Clinton appointees are circuit Judges Frank Hull and Stanley Marcus, while Chief Judge Joel Dubina was tapped by President George H.W. Bush.

Two similar lawsuits are pending in Virginia. Three federal judges, all Democratic appointees, have upheld the law. Two federal judges, both Republican appointees, have invalidated it.

At issue Wednesday is a ruling by U.S. District Judge Roger Vinson, a Republican-appointed judge in Florida. It not only struck down a requirement that nearly all Americans carry health insurance, but it threw out other provisions ranging from Medicare discounts for some seniors to a change that allows adult children up to age 26 to remain on their parents' coverage.

A crush of people gathered outside the 11th Circuit nearly three hours before the arguments were held to guarantee a spot, and the court opened an adjoining courtroom for the spillover crowd. The courtroom was packed with high-profile attorneys and politicians, including Georgia Attorney General Sam Olens, who sat in the front row.

The court also decided to temporarily suspend some of its own rules to sell $26 audiotapes of the arguments to those who want recordings of the court sessions.

Outside the federal courthouse in Atlanta, about 75 people gathered on the sidewalk carrying signs ranging from "Hands off my health care" to "No taxpayer funded abortion" and "Throw the socialist out of the White House." No chanting was permitted. One woman who repeated "No more Tea Party" was escorted away by a courthouse security officer.