Health care law in peril in the courts

The federal health care law, enacted after a bruising battle in Congress, is now imperiled in the federal courts.

Republican officials in 20 states are challenging the constitutionality of the requirement that all Americans have health insurance by 2014.

Attorneys for the federal government argue that the commerce clause of the Constitution allows Congress to regulate “activities that substantially affect interstate commerce,” including the health care market. They contend that the law’s provisions cannot work unless the requirement to be insured applies to everyone, because otherwise people will simply wait until they get sick to buy coverage.

Judge Henry E. Hudson in Federal District Court in Richmond expressed misgivings about the constitutionality of the requirement. He has promised to issue his ruling by the end of the year.

Enemies of the law in Congress and the insurance industry could be expected to exploit an adverse ruling in federal court to sow confusion and mistrust. Such a ruling might also delay or block the steps that insurers, government agencies and the medical professions are taking to implement the many provisions of the law.

It’s expected that any rulings at the district court level would be appealed, ultimately to the U.S. Supreme Court. Given the 5-4 majority of conservative justices, the outcome there is also uncertain.