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This article is part of the State Status and News series related to the Patient Protection and Affordable Care Act.

Michigan Attorney General Mike Cox's legal challenge to sweeping federal health care legislation is a “serious constitutional claim” that has been too readily dismissed by law scholars and some politicians, a Georgetown University law professor said Tuesday.

Randy Barnett, the Carmack Waterhouse Professor of Legal Theory at Georgetown, said there is a realistic possibility the U.S. Supreme Court ultimately could invalidate several of the new law's key provisions as congressional overreach. Barnett was invited by Cox to speak to reporters Tuesday.

Barnett said Congress has never before asserted the authority to require individuals to make a specific purchase or be fined – as the health care legislation would, under a mandate that all American citizens have insurance or pay a fee to the government.

He said new regulations imposed on states as a condition of receiving Medicaid payments were also constitutionally suspect. Both aspects of the new health care law are targets of a lawsuit filed by Cox and 13 other state attorneys general.


Barnett conceded that a majority of scholars across the country have expressed the view that courts will defer to Congress and President Barack Obama on the constitutionality of the health care law.

But he said he thinks that is because many of them have not closely read recent decisions by the court on the limits of federal power.

Bell, Dawson. “Expert Boosts Cox's Health Care Lawsuit”. Detroit Free Press. April 7, 2010. Available online as of 2010-04-07.

The Thomas More Law Center has filed a motion for a preliminary injunction on the enforcement of the individual mandate provision of the newly enacted health care reform act, the Ann Arbor-based law firm announced Tuesday.

It was filed in a federal district court. The government has 21 days to respond. The basis for the lawsuit and the motion is that Congress exceeded its authority under the Constitution by mandating that private citizens purchase health care coverage or face a penalty, according to the press release.

“If Congress can use the Commerce Clause to force people to purchase insurance based on the mere fact that they exist or face federal penalties, then there is no limit to the power of Congress,” said Richard Thompson, president and chief Counsel for TMLC, in the press release. “Our case is about the constitutional limits of our federal government. Everyone agrees the health care system needs reform. But that doesn't mean Congress is allowed to violate the Constitution in the process,”

Whether the injunction is successful depends on how much of a risk a judge will take, says one legal analyst.

“It's going to come down to the individual mandate and how much a judge is going to want to stick his neck out,” said Patrick Wright, senior legal analyst at the Mackinac Center for Public Policy. “This is a gigantic bill that has just gone through a painful political process, and how comfortable is a district court judge going to feel blocking it?”

Gantert, Tom. “Injunction to Stop Federalized Health Care Filed by Michigan Legal Team”. Michigan Capitol Confidential. April 6, 2010. Available online as of 2010-04-07.

On 09-Apr-2010, Representative Bart Stupak, who voted in favor of the PPACA despite abortion concerns, announced his retirement from Congress.

Representative Bart Stupak, the anti-abortion Democrat from Michigan who was central to negotiating a compromise with the Obama administration in passing the health care bill in March, announced on Friday that he would not seek re-election. He said that his main legislative goal — health care reform — had been accomplished and that he was ready to “do other things.” Even so, he has been under intense pressure from Tea Party supporters who opposed the health care overhaul and abortion opponents who said he betrayed their cause.

  • Dan Schnur, former adviser to John McCain
  • Theda Skocpol, professor of government
  • Peter Wehner, former deputy assistant to George W. Bush
  • Lorenzo Morris, political scientist, Howard University
  • Larry Sabato, Center for Politics, University of Virginia
Editors. “Stupak’s Abortion Deal and His Exit” (part of the “Room for Debate” series) New York Times. April 9, 2010. Available online as of 2010-04-12.

According to figures provided by the West Branch Regional Medical Center, the hospital is projected to lose about $13 million during the next 10 years as a result of Medicare cuts stemming from the recently signed federal health care legislation.

WBRMC Director of Communications Sally Ann Whitener said that small rural hospitals such as WBRMC would be particularly impacted by the new legislation. The hospital, which has seen a 17 percent decline in patients during the past two years, has reduced its fiscal year 2011 budget by about $1.5 million, Whitener said.

The expected level of Medicare cuts at WBRMC represents “a staggering number for a small organization,” Whitener said.

Last month, President Barack Obama signed into law the Patient Protection and Affordable Care Act, as well as the Health Care and Education Affordability Reconciliation Act of 2010. Whitener said each of these makes substantial changes to federal law regulating Medicare, Medicaid and private insurance, “all programs West Branch Regional Medical Center relies on for reimbursement for services provided,” she said.

Whitener said the two main effects of the legislation are that the Medicare program is expected to be cut significantly, and that there will be an increase in the number of people eligible for Medicaid.


In the area of Medicaid expansion, she said Medicaid currently pays WBRMC about 72 cents per dollar of cost, so it actually costs WBRMC to provide service to Medicaid recipients.

“Simply put, the more Medicaid patients you serve, the more you lose because reimbursement is below the cost of the care,” Whitener said. “One of the reasons we are seeing obstetric services close in rural areas across the state is because this service traditionally serves a high percentage of Medicaid patients. At WBRMC, our OB service has a Medicaid patient base of about 70 percent.”


“Small rural hospitals can’t continue to provide services that lose such substantial amounts of money and remain viable,” Whitener said, adding that the Michigan Health & Hospital Association predicts the new legislation will cost Michigan hospitals about $7 billion over the course of 10 years.

Compounding the financial situation for hospitals statewide, Whitener said all Michigan hospitals are experiencing a decline in the number of patients served.

“It’s an unfortunate trend across the state,” she said.


She said while it is too early to tell what effect health care reform will have in terms of patient volumes, she expects a rise in the number of Medicaid patients at the hospital.

“It’s probably safe to say we will see an increase in volumes of Medicaid patients as more will be eligible for the program,” Whitener said. “Those newly eligible most likely did not have health care previously so chose not to seek care. With their new coverage they may be more likely to seek care.”

She added that Medicare volumes at WBRMC “will probably stay about the same.”

Whitener addressed the possibility of job losses at hospitals throughout Michigan as a result of the new legislation.

“It’s really early in the process to say, but when you’re talking about an expected loss of about $7 billion for Michigan hospitals, I am sure some jobs will be lost as a result,” she said. “At WBRMC, two-plus years of declining volumes have forced us to reduce our fiscal year 2011 budget by about $1.5 million. To do this, we must adjust our operation to remain viable. Some of those adjustments include reducing both the workforce and supply costs.”


Patrus, Jeff. “Legislation will cut Medicare, increase Medicaid eligibility”. Ogemaw County Hearld (Michigan). April 21, 2010. Available online as of 2010-04-22.