The decision of U.S. District Court Judge Roger Vinson to rule all of the health care reform law constitutional puts into limbo a number of information technology provisions to support reform programs or expand the reach of HIPAA transactions standards. Those I.T. provisions 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,

* Electronic enrollment for public health and human services programs,

* New provider data collection/reporting duties to assess disparities of care,

* A new tax on medical devices, and

* New data collections by the Internal Revenue service to support eligibility determination, documentation and verification processes for premium and cost sharing subsidies.

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

Like Vinson's decision, Judge Henry Hudson of the U.S. District Court for the Eastern District of Virginia in December ruled that the reform law's mandate on individuals to obtain health insurance is unconstitutional. Hudson severed the individual mandate from the rest of the law, which means he did not declare the entire law unconstitutional and other provisions could stand.

But Vinson, senior judge in the Northern District of Florida, Pensacola Division, went further. In declaring the individual mandate unconstitutional, he also ruled, with reluctance, that 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 the 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.'"

Following the ruling, the Justice Department almost immediately announced it would file an appeal with the U.S. Court of Appeals for the 11th Circuit in Atlanta. The Obama Administration has not decided whether to seek a stay on Vinson's ruling to continue implementing provisions of the law during the appeals process. All sides of the reform issue agree the Supreme Court eventually will decide the constitutionality of all or portions of the reform law.

Judge Vinson's ruling is available here.

--Joseph Goedert


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