Supreme Court Picks Florida Case for Health Reform Ruling

The Supreme Court has officially announced it will consider the constitutionality of the health care reform law during its current term, with an opinion expected in May or June 2012.

The court has selected to review the Florida Court of Appeals ruling that the individual mandate in the reform law is unconstitutional and cannot be separated from the rest of the law, and therefore the entire law is void.

Judge Roger Vinson, senior judge in the Northern District of Florida, Pensacola Division, with reluctance, ruled the mandate was not severable from the rest of the law because while the mandate was "necessary and essential" to the law as written, it is not "necessary and essential" to health care reform in general.

"Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void," according to Vinson's ruling. "This has been a difficult decision to reach, and I am aware that it will have indeterminable implications. At a time when there is virtually unanimous agreement that health care reform is needed in this country, it is hard to invalidate and strike down a statute titled, "The Patient Protection and Affordable Care Act.'"

Vinson made clear that his ruling was based on constitutionality issues and not the merits of the reform law itself. "I emphasized once before, but it bears repeating again: this case is not about whether the Act is wise or unwise legislation, or whether it will solve or exacerbate the myriad problems in our health care system. In fact, it is not really about our health care system at all. It is principally about our federalist system, and it raises very important issues regarding the Constitutional role of the federal government."

There are multiple ways the Supreme Court could rule, including among others: The individual mandate is constitutional so the law stands as is; the individual mandate is unconstitutional but everything else in the law is constitutional; or the individual mandate is unconstitutional and renders the entire law unconstitutional.

Information technology provisions in the reform law that would be affected by a Supreme Court ruling include:

* New "operating rules" to further standardize HIPAA transactions;

* Two new HIPAA transactions--electronic funds transfer and claims attachments--and the long-delayed health plan identifier;

* State insurance exchanges to ease consumer comparison and purchase of coverage;

* Availability of Medicare claims data for research and analysis;

* Electronic enrollment for public health and human services programs; and

* A new tax on medical devices including devices that collect and/or transmit data, such as patient monitors.

Also in limbo are Medicare and Medicaid accountable care organization programs, which would rely heavily on I.T. to improve coordination across the continuum of care.