Amicus Brief in Support of Virginia - Cuccinelli Lawsuit Against Obama Care - Fourth Circuit

8/7/2019 Amicus Brief in Support of Virginia - Cuccinelli Lawsuit Against Obama Care - Fourth Circuit

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Nos. 11-1057 & 11-1058

IN THE UNITE D STATES

COURT OF APP EALS F OR THE FOURTH CIRCUIT

COMMONWEALTH OF VIRGINI A,

ex rel. Kenn eth T. Cuccinelli, II, in h is

Official Capacity as Att orney Gen era l of Virgin ia.

Plaintiff-Appellee/Cross-Appellant ,

v.

KATHLEE N SEBELIUS,

Secreta ry of t he Depart men t of Health

an d H um a n Ser vices, in her Official Capacity,

Defendant -Ap pellant/Cross-A ppellee.

On Appeal from t he Un ited Stat es Distr ict Court

for t he E ast ern Distr ict of Virginia

BRIEF OF ASSOCIATION OF AMERICAN P HYSICIANS AND

SURGE ONS, INC., J ANIS CHE STER, M.D., MARK J . HAUSER, M.D.,

GUE NTER L. SP ANKNE BEL, M.D., AND GRAHAM L. SPRU IE LL,

M.D., AS AMICI CURIAE IN SUP PORT OF APP ELLEE /CROSS-

APPELLANT

DAVID P. FE LSH ER ANDREW L. SCHLAFLY

488 Madison Avenue 939 Old Chest er Rd.

New Yor k, NY 10022 Fa r Hills, NJ 07931

(212) 308-8505 (908) 719-8608

(212) 308-8582 (fa x) (908) 934-9207 (fa x)

Apr il 4, 2011 At torneys for Am ici Curiae



UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

DISCLOSURE OF CORPORATE AFFILIATIONS AND OTHER INTERESTS

Only one form needs to be completed for a party even if the party is represented by more than

one attorney. Disclosures must be filed on behalf of all parties to a civil, agency, bankruptcy or

mandamus case. Corporate defendants in a criminal or post-conviction case and corporate amici

curiae are required to file disclosure statements. Counsel has a continuing duty to update thisinformation.

_______ Caption: __________________________________________________No.

Pursuant to FRAP 26.1 and Local Rule 26.1,

______________________ who is _______________________, makes the following disclosure:

(name of party/amicus) (appellant/appellee/amicus)

1. Is party/amicus a publicly held corporation or other publicly held entity? YES NO

2. Does party/amicus have any parent corporations? YES NO

If yes, identify all parent corporations, including grandparent and great-grandparent

corporations:

3. Is 10% or more of the stock of a party/amicus owned by a publicly held corporation or

other publicly held entity? YES NO

If yes, identify all such owners:

4. Is there any other publicly held corporation or other publicly held entity that has a direct

financial interest in the outcome of the litigation (Local Rule 26.1(b))? YES NO

If yes, identify entity and nature of interest:

5. Is party a trade association? (amici curiae do not complete this question) YES NO

If yes, identify any publicly held member whose stock or equity value could be affected

substantially by the outcome of the proceeding or whose claims the trade association ispursuing in a representative capacity, or state that there is no such member:

6. Does this case arise out of a bankruptcy proceeding? YES NO

CERTIFICATE OF SERVICE

**************************

I certify that on _________________ the foregoing document was served on all parties or their

counsel of record through the CM/ECF system if they are registered users or, if they are not, by

serving a true and correct copy at the addresses listed below:

_______________________________ ________________________

(signature) (date)

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iii

TABLE OF CONTE NTS

Corpora te Disclosure St a t em en t .................................................................... ii

Ta ble of Con ten ts ............................................................................................ iii

Ta ble of Authorit ies ........................................................................................ iv

Int erests of Am ici Cu riae ................................................................................ 1

Preliminary St a t em en t ................................................................................... 4

Summary of Argument.................................................................................... 7

Argumen t ......................................................................................................... 8

I. Section 1501 is Unconst it u t iona l ........................................................... 8

A. Sect ion 1501 is Not Ba sed on Congr ess’ Power t o Regulat e

Commer ce ................................................................................................. 9

1. The individu a l manda te involves no commer ce .................... 10

2. Cour t s ma y not re ly on Sect ion 1501’s “findings” t o est a blish

Congr essiona l power und er t he Com merce Clau se ............... 13

B. Congress May Not Violat e Cons t itu tiona l Const rain t s .................. 15

1. Section 1501 ma y not be ena cted a nd a men ded

simultaneously ......................................................................... 16

2. Congr ess m ay not in vade a pa t ient ’s pr ivacy ......................... 20

II. ACA is Un const itu tiona l Becaus e Sect ion 1501 I s N ot Severa ble ...... 24

Conclusion ...................................................................................................... 28

Cer t ificat e of Com pliance .............................................................................. 29

Cer t ificat e of Ser vice ..................................................................................... 30



iv

TABLE OF AUTHORITIE S

CASES

Alask a A irlines v . Brock , 480 U.S . 678 (1987) .............................. 7, 8, 24, 26

Ass ociation of Am erican P hy sicians an d S urgeons, In c. v. S ebelius ,

Ca se No. 1:10-cv-0499-ABJ ................................................................... 2

Clinton v. City of N ew Y ork , 524 U.S. 417 (1998) .............................. passim

Com m onw ealth of V irgin ia, ex rel. Cu ccinelli v. Sebelius , 728 F. Supp . 2d

768 (E.D. Va. 2010), appeals dock eted , Nos. 11-1057 & 1058 (4th

Cir.) .............................................................................................. passim

Florida v. United S tates Departm ent of Health and H um an S ervices,

(N.D. Fl.), Case No.: 3:10-cv-91, appeal docketed , 11-11021-HH (11t h

Cir.) .............................................................................................. passim

Free Ent er. Fun d v. Pub. Co. Account ing Oversight Bd .,

130 S.Ct . 3138 (2010) ............................................................................ 8

Gibbons v. Ogden , 22 U.S. (9 Wheat.) 1 (1824) ........................................... 12

Im m igration and N atu ralization S ervice v. Chadha ,

462 U.S. 919 (1983) .................................................................. 16, 25, 26

Liberty University v. Geithner , __ F. Su pp. 2d __, 2010 WL 4860299 (W.D.

Va. Nov. 30, 2010 ), appeal docketed , No.10-2347 (4th Cir .) ........... 5, 9

Marbury v. Madison, 5 U.S. (1Cr .) 137 (1803) ............................................ 14

McCulloch v. Maryland , 17 U.S . (4 Wh ea t .) 316 (1819) ............................ 8-9

Mead v . Holder , __ F.Su pp.2d ___, 2011 WL 611139 (D.D.C.), appeal

docketed , 11-5047 (D.C. Cir .) ............................................................ 5, 9

Miranda v. Arizona, 384 U.S. 436 (1966) .................................... 7, 22, 23, 24



v

Mu rphy v . W aterfront Com m ission of New Y ork Harbor ,

378 U.S. 52 (1964) ................................................................................ 22

New Y ork v. U.S ., 505 U.S. 144 (1992) ................................................... 24-25

O’Conn or v. Ort ega, 480 U.S. 709 (1987) ..................................................... 22

Oklahoma v. S ebelius , Case No.: 6:11-cv-00030 (E.D. Ok .) ......................... 5

Silverm an v. Un ited S tates, 365 U .S. 505 (1961) ....................................... 22

S ten berg v. Carhart , 530 U.S. 914 (2000)...................................................... 1

Tehan v. United St ates ex rel. S hott , 382 U.S. 406 (1966)......................... 22

Th om as More Law Center v. Obam a, 720 F.Su pp. 2d 882 (E.D. Mi. 2010),

appeal docketed , No. 10-2388 (6th Cir.) ........................................... 5, 9

Un ited S tates v. Grunew ald , 233 F.2d 556 (2d Cir. 1956),

rev’d , 353 U.S. 391 (1957) ........................................................ 21, 22, 23

Un ited Stat es v. Lopez, 514 U.S. 549 (1995) ............................................... 12

Un ited St ates v. Morrison , 529 U .S. 598 (2000)............................................ 8

United States v. On Lee, 193 F .2d 306 (2d Cir. 1951),

aff’d , 343 U.S. 747 (1952) ............................................................... 21, 22

Un ited St ates v. W estingh ouse Electric Corp.,

638 F.2d 570 (3d Cir. 1980) ....................................................... 7, 20, 21

CONSTITUTION

U.S. CONST. a r t . I ........................................................................................ 18

U.S. CONST. art. I, sec. 1, cl. 1 .............................................................. 26, 27



vi

U.S. CONST. a r t . I , sec. 7 ............................................................................... 9

U.S. CONST. art. I, sec. 7, cl. 2 ........................................................... passim

U.S. CON ST. a r t . I , sec. 8 ............................................................................. 10

U.S. CONST. art. I, sec. 8, cl. 3 ............................................................ passim

U.S. CONST. a r t . I , sec. 9 ............................................................................... 9

U.S. CONST. a r t . VI ........................................................................................ 6

U.S. CONST. a men d. I V ............................................................................... 22

U.S. CONST. amen d. V ................................................................................. 22

STATUTES

26 U.S.C. § 5000A ............................................................................. 16, 17, 18

Hea lth Car e a nd Ed ucation Reconciliat ion Act of 2010, Pu b. L. 111-152,

124 Sta t . 1029 ................................................................................... 2, 19

Pa tient Pr otection a nd Afford able Car e Act, P ub. L. 111-148,

124 S ta t . 119 (2010) .................................................................... passim

§ 1501 ................................................................................................ passim

§ 1501(a) .................................................................................................... 13

§ 1501(a)(2)(E) ..................................................................................... 14, 15

§ 1502 ......................................................................................................... 20

§ 10106 ..................................................................................... 14, 15, 16, 17

§ 10106(a ) .................................................................................................. 13



vii

Title X ........................................................................................................ 18

CONGRE SSIONAL MATERIALS

Brief of Senat ors Robert C. Byrd , Dan iel Pa tr ick Moyniha n, an d Car l

Levin a s Am ici Curiae in Support of Appellees 9-10 in Clint on v.

City of N ew Y ork (Docket No. 97-1374) ............................................. 26

H. R. 3590 (111t h Cong.) ................................................................... 17, 18, 27

H. R. 4872 (111t h Cong.) .............................................................................. 19

U.S. Congress, Office of Technology Assessment , Protectin g Privacy in

Com put erized M edical Inform ation , OTA-TCT-576 (U.S. G.P.O.,

Sept . 1993) ............................................................................................ 20

RULES

S. Ct . R. 11 ....................................................................................................... 4

OTHER AUTHORITIES

Abraha m Lin coln, Speech of J une 16, 1858 (Spr ingfield, Ill.)

reprint ed in Yale Book of Quotat ions 460 (F .R. Shapiro ed.

2006)….................................................................................................. 4

Albert Einst ein, Th e Meaning of Relativity (5th ed. 1956) ........................ 11

Dan iel H uff, How to Lie with S tatistics (1954) ...................................... 14-15

Empire BlueCr oss/BlueShield F orm ENR-02968 (Rev 1/11) ..................... 23



viii

Er nst & Young, LLP, S um m ary of t he Patient Protection and Affordable

Care Act, incorporating T he H ealth Care and E ducation

Reconciliation Act (May 2010) ............................................................ 19

Euclid, Elem ents of Geom etry (Greek Text of J . L. Heiber g (1883-1885))

(R. F itzpa t r ick, ed. & t ransla tor) ........................................................ 11

GAO, PRIV ACY : Dom estic and Offshore Out -sourcing of Personal

In form ation in M edicare, Medicaid, and T RICA R E, Report No. 06-

676 (Sep t . 2006) .................................................................................... 24

J am es M adison, THE FE DERALIST No. 62 (C. Ross iter , ed. 1961) ......... 18

Micha el O. Leavit t, “Healt h reform’s cent ral flaw: Too much p ower in one

office,” Washington Post (Febr uary 18, 2011) .................................... 19

Pa ul A. Sam uelson, Econom ics (10 t h ed., 1976) .......................................... 11



1

INTERE STS OF AMICI CURIAE 1

Amici Curiae (“Amici”), which file this Brief with the consent of all

the parties, are individual physicians and an association of physicians

having a membership that spans the nation. Amici file this brief in

support of the Commonwealth of Virginia (“The Commonwealth” or

“Virginia") (Appellee/Cross-Appellant) and in opposition to Kathleen

Sebelius, Secreta ry of t he Depar tm ent of Health an d H um an Services, in

her Official Ca pacity (“The S ecreta ry”) (Appellant /Cross-Appellee).

Since 1943, Amicus Association of American Physicians and

Surgeons, Inc. (“AAPS”) has been dedicated to the highest ethical

sta nda rds of th e Oath of Hippocr at es an d to preserving the sa nctity of th e

pat ient-physician relat ionsh ip. AAP S ha s filed nu mer ous am icus curiae

briefs in notewort hy cases like th is one . S ee, e.g, S ten berg v. Carhart , 530

U.S. 914 (2000)(citing an AAPS am icus brief). Because AAPS has also

commenced an action against The Secretary which contains overlapping

allegations of unconstitutionality, the disposition of these Appeals may

1 No counsel for a pa rt y au th ored t his brief in whole or in par t. No person

or entity other than am ici curiae or their counsel made a monetary

contribution to the preparation or submission of this brief. All parties

cons ent ed t o th e filing of t his Br ief.



2

affect the rights of AAPS and its members. Association of American

Physicians an d S urgeons, In c. v. Sebelius , Case No. 1:10-cv-0499-ABJ .

Amicus Guenter L. Spanknebel, M.D., privately practiced

gastroenterology. He is a past president of the Massachusetts Medical

Society and is currently chair of its History Committee. He has also

served as a Trustee of the Health Foundation of Central Massachusetts

and on the faculties of the medical schools at Tufts University and the

University of Massachusetts.

Amicus Janis Chester, M.D., privately practices psychiatry in

Delaware, serves as chair of the Department of Psychiatry at a

community hospital, is a member of the faculty at Jefferson Medical

College and holds a variety of positions with organized medicine and

psych iatr y, locally an d na tionally.

Amicus Mark J. Hauser, M.D. privately practices psychiatry and

foren sic psychia tr y in Massa chuset ts a nd Conn ecticut.

Amicus Graham Spruiell, M.D., privately practices forensic

psychiat ry a nd psychoana lysis in t he Boston a rea.

Amici have followed attempts in recent years to enact health care

reform legislat ion. As active mem bers of th e medical profession a nd



3

pursuant to their ethical obligations, Amici have carefully studied the

introduction, passage and partial early implementation of the Patient

Protection and Affordable Care Act, Pub. L. 111-148, 124 Stat. 119 (2010)

(“ACA”), amended by Health Care and Education Reconciliation Act of

2010, Pub. L. 111-152, 124 Stat. 1029 (“RA”). Amici have also filed a brief

in sup port of The Commonwea lth’s Rule 11 Petition to th e United S ta tes

Supreme Court .

For the reasons set forth below, Amici believe ACA is

unconstitutional. If upheld, ACA will harm patients and undermine, in

fundamental and dangerous ways, the practice of medicine. Amici submit

th is br ief in s upport of The Comm onwealth an d u rge th e Cour t to affirm

Section 1501’s u nconst itu tionality an d t o fur th er h old th at Section 1501 is

not severa ble from t he r ema inder of ACA.



4

PRE LIMINARY STATEME NT

ACA has divided our nation prior to enactment, during enactment

and since enactment. Cf. Abraham Lincoln, Speech of June 16,

1858(Springfield, Ill.) reprinted in Yale Book of Quotations 460 (F.R.

Shap iro ed. 2006)( “[a ] hous e divided against it self cannot st and”).

The Commonwealth has challenged the constitutionality of the

individual m and at e cont ain ed in S ect ion 1501 of ACA (“Section 1501”) and

of ACA itself. The Un ited St at es Distr ict Court for t he Ea ster n Distr ict of

Virginia held Section 1501 is unconstitutional and severable from the

rema inder of ACA and both par ties appealed. Commonwealth of Virginia,

ex rel. Cuccinelli v. Sebelius , 728 F. Supp. 2d 768 (E.D. Va.

2010)(“Virginia Action”), appeals docketed , Nos. 11-1057 & 1058 (4th

Cir.)(“V irginia A ppeal”). The Commonwealt h ha s also filed a Pet ition for

Writ of Certiora ri before J udgment . Un ited Sta tes Supr eme Cour t Docket

No. 10-1014.2

Besides Vir ginia , twent y-seven other st at es ha ve cha llenged Section

1501’s and ACA’s const itu t iona lity. Twenty-six states are plaintiffs in

2Pursuant to Rule 11 of the Rules of the Supreme Court.



5

Florida v. United S tates Departm ent of Health and H um an S ervices (N.D.

Fl.), Case No.: 3:10-cv-91(“Florida Action”), appeal docketed , No. 11-

11021-HH (11 th Cir .) (“Florida Appeal”), where the court declared Section

1501 to be unconstitutional and not severable from the remainder of

ACA.3 Florida Action, Doc 151. Conversely, in Liberty University v.

Geithner , __ F. Supp. 2d __, 2010 WL 4860299 (W.D. Va. Nov. 30,

2010)(“Liberty Action”), appeal docketed, No.10-2347 (4th Cir.) (“Liberty

Appeal”),4 Th om as More Law Center v. Obam a, 720 F.Supp. 2d 882 (E.D.

Mi. 2010)(“TM LC A ction”), appeal dock eted , No. 10-2388(6th Cir.)(“TMLC

Appeal”), and Mead v. Holder , __ F .Supp. 2d ___, 2011 WL 611139

(D.D.C.)(“Mead Action”), appeal docketed , 11-5047 (D.C. Cir.)(“Mead

Appeal”), the courts found Congress has power to enact Section 1501

under the Commerce Clause. In total, more than twenty cases have been

commenced challenging ACA and its provisions. Plaintiffs/Appellants

Petition for Initial En Banc Hearing, Mead Appeal, at 8 (“Mead En Banc

Petition”).

3 Oklahom a h as a lso comm enced a separa te a ction. Ok lahoma v. S ebelius ,

Case N o.: 6:11-cv-00030 (E .D. Ok.).

4 The Four th Circuit ordered th e Virginia A ppeal to be hear d in seriatum

with t he Liberty A ppeal. Virgin ia A ppeal, Order dat ed J an . 26, 2011.



6

In addition to Section 1501, Amici believe that ACA contains scores

of unconst itut iona l provisions wh ich a re not severa ble from t he r ema inder

of ACA.5 It is axiomatic that whenever a statute contains any

un const itutiona l provision t ha t is not severa ble from t he r emainder of the

statute, no provision of that statute may be treated as the Supreme Law

of th e Lan d pu rs ua nt to Art icle VI. U.S. CONST. art . VI.

Consequently, quickly declaring ACA unconstitutional would

unburden the federal Judiciary and the Executive Branch as well as the

sta tes from year s of un necessar y an d costly litigation. F ur th ermore un til

ACA is declared unconstitutional states (including Virginia), consumers,

employers an d oth ers wou ld spend additional billions of dollar s t o com ply

with an unconstitutional statute and billions of dollars will be withdrawn

from t he Trea sur y based upon a n u nconst itu tional law. Virginia’s daily

expenditu res t o comply with ACA unqu estionably provide it with st an ding

to cha llenge ACA’s cons t itu t iona lity.

5

These provisions, including Section 1501, violate Article I, Section 7,Clause 2 of the Constitution (“Presentment Clause”) because they were

simultaneously enacted and amended. S ee Section I, B, 1, infra.

Furthermore, the test for severability should be reexamined because

severance of an unconstitutional provision from a statute lacking a

severability clause is a judicial line item veto, a judicial remedy which

itself violates t he P resentm ent Clause. S ee Section II , infra.



7

SUMMARY OF ARGUME NT

Amici believe Congress lacks power to enact Section 1501 for two

rea sons. Fir st, there is no power to r egulate comm erce becau se t her e is no

commerce. S ee U.S. CONST. art. I, sec. 8, cl. 3 (“Commerce Clause”).

Second , Sect ion 1501 fails to comply with t he Cons t itu tion’s pr ocedu ra l

requirements and substantive restrictions. Procedurally, Congress

violated the Presentment Clause by simultaneously enacting and

amending Section 1501. Substantively, Section 1501 invades the “private

enclave” enjoyed by patients since the time of Hippocrates. S ee United

States v. Westinghouse Electric Corp., 638 F.2d 570 (3d Cir. 1980);

Miranda v. Arizona, 384 U.S. 436 (1966).

The Secret ar y’s a rgum ent th at Section 1501 is severa ble from ACA

can not succeed. Congress ha s declared an d The Secreta ry has argu ed

that Section 1501 is “essential” to ACA. Furthermore, even if The

Secret ar y could est ab lish S ect ion 1501’s severa bilit y under Alaska

Airlines v. Brock , 480 U.S.678 (1987), severance (from a statute lacking a

severability clause) is a judicial line item veto that transfers legislative

power from Congress to the judiciary in violation of the Bicameral and

Pr esent ment Clauses - ignoring t he pr inciples set fort h in Clint on v. City



8

of New Y ork , 524 U.S. 417 (1998). Severa nce is not, as pr evious ly held by

the U.S. Supreme Court, a doctrine of judicial restraint. Cf. Order

Grant ing Summary Judgment , Florida Action , Doc 150 at 64;

Memora ndu m Opinion, Virginia A ct ion , Doc 161 a t 40.

The Court observed that “[s]everability is a doctrine of judicial

restraint,” and that “just this past year,” the Supreme Court

reaffirmed that courts should “try to limit the solution to the

problem,” severing any problematic portions while leaving the

remainder intact ,” and that the normal rule is that part ial

invalidation is pr oper. Op. 64 (quoting Free E nt er. Fund v. Pub. Co.

Accoun ting Oversight B d., 130 S.Ct . 3138, 3161 (2010).

Memoran dum in Su pport of Defenda nt s’ Motion t o Clarify, Florida Action ,

Doc 156 (“Clarification Motion”) at 3. Rather, severance is a doctrine of

jud icial activism t ha t allows, an d possibly even encour ages, constitu tional

sloppiness by Congress and th e President . In light of Clinton , Amici

suggest Alaska Airlines an d its pr ogeny no longer app ly.

ARGUMENT

I. SE CTION 1501 IS UNCON STITUTIONAL

“Every law enacted by Congress m us t be based on one or more of its

powers enumerated in the Constitution.” United States v. Morrison , 529

U.S. 598, 607 (2000); McCulloch v. Maryland , 17 U.S. (4 Wheat .) 316, 405



9

(1819). Those powers ar e constr ain ed by th e Constitu tion’s pr ocedur al

requirements, see e.g., U.S. CONST., art. I, sec. 7, and substantive

restrictions, see e.g., id. at sec. 9.

A. Section 1501 is Not Based on Congress’ Power to Regulate

Commerce

The Secretary has argued that Congress may enact Section 1501

un der th e Comm erce Clause. Becau se Section 1501 does not involve a ny

comm erce, her ar gum ent fails.

Since ACA was enacted last year, the question of whether Congress

has the power to enact Section 1501 under the Commerce Clause has

ar isen in ma ny cases. Section 1501 was u pheld in th e Liberty, Mead and

TMLC Actions but was declared unconstitutional in the Florida and

Virginia Actions.6

Given the disparity of the opinions and the gravity of the issue, the

question of Congressional power to enact Section 1501 should be decided

by th is Cour t. Amici offer t he following an alysis to the Cour t .

6 The courts in the Florida and Virginia Actions disagreed on whether

Section 1501 is severable from ACA. The Virginia Action held Section

1501 is s evera ble. The Florida A ction held it is not severa ble.



12

The commerce power “is the power to regulate; that is, to prescribe

the rule by which commerce is to be governed …” The Gibbons

Court, however, acknowledged that limitations on the commerce

power ar e inherent in th e very langu age of th e Comm erce Claus e.

It is not intended to say that these words comprehend that

commerce, which is completely internal, which is carried on

between m an and m an in a St at e, or between differen t pa rt s of

the same State, and which does not extend to or affect other

States….

United States v. Lopez, 514 U.S. 549, 553 (1995)(quoting Gibbons v.

Ogden , 22 U.S. (9 Wheat.) 1, 194-95 (1824)(Marshall, Ch. J.)(emphasis

added).

While “commerce” may occur between two people, between two

entities, or between a person and an entity, there is no “commerce” when

a single person or entity is involved. Since Section 1501 is an individual

mandate, it does not pertain to a transaction, agreement, traffic or

interr elat ionsh ip between two par ties. Rath er Section 1501 at tempt s to

regulate individuals where no counterparty exists. The individual

man da te involves no “commerce”. With out “comm erce”, there is no need t o

exam ine th e inter sta te comm erce su b-clause.



13

2. Cour t s m ay not r ely on S ect ion 1501’s “findings” t o esta blish

Congressiona l power u nder th e Comm erce Clause

Amici believe the “substantial effects” test leads to false positive

resu lts a nd shou ld not be t he sole basis t o esta blish Section 1501’s

const itu tiona lity u nder th e Comm erce Clau se.

The Secreta ry ha s pointed t o a litan y of Congressional “findings” to

argue that Congress properly enacted Section 1501 under the Commerce

Clau se - on th e basis th at th e lack of adequa te insu ra nce covera ge has a

subst an tia l effect upon t he economy. Defendan t’s Motion for Sum ma ry

Judgment , Virginia Action, Doc 91, at 4, 7, 8, 11-13, 15-16, 21, 26-27, 33

(point ing to find ings in §§ 1501(a) & 10106(a). Applying t his r at iona le, a

court could easily find the other enumerated powers of Congress

super fluous . The powers t o declar e war , est ablish post offices, and

provide exclusivity for inventors obviously have substantial economic

effects. Un der The Secret ar y’s th eory, these claus es are unnecessar y.

While a court may refer to Congressional findings to support its

conclusion that Congress has power to enact a provision, a court must be

able to examine Congressional “findings” if judicial review is to have any



14

meaning.8 No deference is war ra nt ed. In th is case, Congr ess pres ent ed

findings which were bas ed on nu mer ous a ssum ptions an d extra polations,

some of which contradict each other. Compare Sections 1501(a)(2)(E) and

10106.

Whenever Congress presents “findings”, those so-called “findings”

are not facts at all, but rather something else - a conclusion based on a

vote. Congressiona l “findings” oft en involve num erous extr apolat ions

based on a plethora of assumptions. More than a century ago, Mark

Twain h um orously expressed t he da ngers of extra polat ion as follows:

In the space of one hundred and seventy-six years the Lower

Mississippi has shortened itself two hundred and forty-two miles.

That is an average of a trifle over one mile and a third per year.

Ther efore, a ny calm per son, who is n ot blind or idiotic, can see th at

in the Old Oolitic Silurian Period, just a million years ago next

November, the Lower Mississippi River was upward of one million

three hundred thousand miles long, and stuck out over the Gulf of

Mexico like a fishin g-rod. And , by th e same token a ny person can

see that seven hundred and forty-two years from now the Lower

Mississippi will be only a mile an d t h ree-qua rt ers long….

8 When a cour t blind ly accepts Congress ional findings as facts, it a moun ts

to a dereliction of its duties. Long ago, the U.S. Supreme Court said: “[i]t

is emphatically the province and duty of the judicial department to say

what th e law is.” Marbury v. Madison, 5 U.S. (1Cr.) 137, 177 (1803). It is

not free to “close [its] eyes on the Constitution, and see only the law, [e.g.

ACA].” Id . at 178.



16

ACA. As cit izens , Amici are concerned that Congress repeatedly violated

the P resentment Clause by simu ltan eously enacting and amending ma ny

of ACA’s provisions, including Section 1501. Therefore, the Court should

affirm th e u nconst itu tionality of Section 1501.

1. Section 1501 m ay not be enacted an d am ended simulta neously

Congress has simultaneously enacted Sections 1501 and 10106 of

ACA. The former provision creates 26 U.S.C. §5000A, 124 Stat. at 244,

while the latter provision revises some portions of 26 U.S.C. §5000A, 124

St at . at 909. These pr ovisions cont ain incom pa tible definitions of “penalt y

amount.”

Congress may not simultaneously enact and revise any provision

within the same statute because that simultaneity violates the

Presentment Clause, the “single, finely wrought and exhaustively

considered, procedure” which is used to enact Federal legislation.

Immigration and Naturalization Service v. Chadha, 462 U.S. 919,

951(1983); Clinton , 524 U.S. at 439-440.

Although simultaneously enacting and revising 26 U.S.C. §5000A

may have led to needless complexity, incongruity, and ambiguity for our

citizenr y an d judiciar y, t he crit ical constitu tional problem is tha t both t he



17

original and revised versions of Section 5000A were presented to the

Pr esident a t t he sa me t ime. Consequen tly, 26 U.S.C. §5000A did not exist

at th e times the H ouse an d Senat e passed H.R. 3590 nor did it exist when

H.R. 3590 was pr esent ed to th e Pr esident. Consequ ent ly, Section 10106

mer ely at tem pts to am end a nu llity. For 26 U.S.C. §5000A to be

revisable, Section 10106 must be enacted after section 1501, not

simultan eously with it .

Under the Presentment Clause, the President may only approve or

veto a bill in its entirety. Because Sections 1501 and 10106 contained

incompatible definitions of “penalty amount,” it is impossible for the

Pr esident t o ha ve appr oved H.R. 3590 (which becam e ACA) in its en tiret y.

The P resident ’s a pproval of th e definition in 1501 contr ad icted t he

definition pr esent ed to him in 10106 an d th e Pr esident ’s appr oval of th e

definition in 10106 contradicted the definition in 1501. The incompatible

definitions of “penalty amount” contained in Sections 1501 and 10106

prevented the House and Senate from having agreed on the definition of

“pena lty am ount .” In other words , th e House’s definition un der 1501

negat ed th e Sena te’s defin ition u nder 10106 an d t he H ouse’s definit ion

un der 10106 negated t he Sena te’s definition u nder 1501.



18

“[R]epeal of statutes, no less than enactment, must conform to Art.

I.” Clinton , 524 U.S. at 438. The sa me prin ciple applies to revisions a nd

am endm ent of st at ut es. Consequen tly, 26 U.S.C. §5000A should not have

been enacted an d revised with in the same statu te. This un const itut iona l

practice completely infects ACA. Indeed, pursuant to Title X, Congress

attempted to simultaneously enact and amend more than ninety ACA

provisions.9

Dur ing debate over t he Const itut ion’s ra tificat ion, J am es Madison

stated that laws should be understandable, not too long, and “not be

revised before they ar e prom ulgat ed.” THE F E DERALIST No. 62, at

381(Ma dison) (C. Rossit er, ed . 1961). He wr ote:

The int ern a l effects of a m ut able policy ar e st ill more calamitous. It

poisons the blessings of liberty itself. It will be of little avail to the

people that t he laws a re m ade by men of t heir own choice if th e laws

be so voluminous that they cannot be read, or so incoherent that

th ey can not be un ders tood; if th ey be repealed or r evised before t hey

are promulgated, or undergo such incessant changes that no man,

who knows what the law is today, can guess what it will be

tomorr ow. Law is defined to be a r u le of action; but h ow can th at be

a r u le, which is little known, an d less fixed?

Id . (emph asis a dded). Congr ess ignor ed Madison’s pr escient wa rn ing an d

passed H.R. 3590, a 2400 page bill, which became ACA upon the

9 124 Sta t. at 883-1024.



19

Pr esident’s signat ur e. Within days of passing ACA, Congr ess a lso pass ed

H.R. 4872 which becam e the Reconciliat ion Act .

Given ACA’s length a nd t he num ber of simu lta neously enacted an d

amended provisions, James Madison surely would have considered ACA

too long a nd too incoher en t t o be un der st ood. Indeed, ACA’s lengt h a nd

complexity have not gone unnoticed. S ee Order, Florida Action , Doc 167

at 16 (“[ACA], as previously noted, is obviously very complicated and

expansive. It contains about 450 separate provisions with different time

schedules for implementation.”); see also Michael O. Leavitt, “Health

reform’s cent ral flaw: Too mu ch power in one office,” Washin gton Post

(February 18, 2011)(referring to nearly 2000 powers given to The

Secret ar y by ACA); see also Er nst & Youn g, LLP, Summ ar y of th e Pa tient

Protection and Affordable Care Act, incorporating The Health Care and

Educat ion Reconciliat ion Act (May 2010)(This summary is presented in a

sm all font an d is 159 pa ges long).



20

2. Congr ess ma y not invade a pat ient’s pr ivacy

The individual mandate is an assault on the confidentiality of the

physician- patient relationship.10 For more than two millennia,

physicians and patients have understood that a patient receives better

care if the patient candidly discloses private information, e.g. medical

history, sympt oms , an d tr eat men ts, to th e physician. U.S. Congr ess,

Office of Technology Assessment, Protecting Privacy in Computerized

Medical Information , OTA-TCT-576 (pages 5-6, 26-30)(U.S. G.P.O., Sept.

1993). To ma nda te t he pur cha se of m edical insur ance and th en t o require

disclosur e of th at insu ra nce is ta nt am oun t to providing th e govern men t,

as well as en tities it out sour ces to, with a r oadma p to pat ients’ medical

inform at ion. Un der the Const itut ion, a patient ha s a right t o a “privat e

enclave” where his or her medical care and information are private. The

individua l ma nda te obliterat es th at enclave.

In Westinghouse , the Third Circuit eloquently applied the “private

enclave” principle to a case involving confidentiality of medical

information:

10 This a ssa ult is compoun ded by Section 1502’s compelled disclosu re of

coverage.



21

Ther e can be no quest ion th at an employee’s m edical r ecords , which

ma y cont ain int imat e facts of a personal n at ur e, ar e well wit hin t he

am bit of m at erials entitled to privacy pr otection. In form at ion about

one’s body an d st at e of hea lth is m at ter which t he ind ividua l isordinarily entitled to retain within the “private enclave where he

ma y lead a privat e life.”

Id . at 577 (quoting United States v. Grunewald , 233 F.2d 556, 581-82 (2d

Cir. 1956)(Frank, J., dissenting), rev’d , 353 U.S. 391 (1957)). In

Grunewald , J udge Fr ank said:

That r ight is th e ha llma rk of our democra cy. The totalita rian

regimes scornfully reject that right. They regard privacy as an

offense a gainst th e st at e. Their goal is ut ter depersona lization.

They seek to convert all that is private into the totally public, to

wipe out all un ique “pr ivat e worlds,” leaving a “pu blic wor ld” only, a

la Orwell’s ter r ifying book, “1984.” They boas t of t he res ult a nt

greater efficiency in obtaining all the evidence in criminal

pr osecut ions. We sh ould kn ow by now th at t heir vau nt ed efficiency

too often yields, unjust, cruel decisions, based upon unreliable

eviden ce procur ed at t he sa cr ifice of pr ivacy. We sh ould be awar e of

moving in the direction of totalitarian methods, as we will do if we

eviscera te an y of the const itut iona l pr ivileges.

Grunewald , 223 F.2d at 582. Pr eviously, J udge Fr an k described the right

to a “private enclave” in Un ited S tates v. On L ee, 193 F.2d 306, 315-16 (2d

Cir. 1951) (Fr an k, J ., dissent ing), aff’d , 343 U.S.747 (1952):

“A man can still control a small part of his environment, his house;

he can retreat thence from outsiders, secure in the knowledge that

th ey can not get at him without disobeying th e Const itut ion. That is

st ill a siza ble hun k of libert y – wort h protecting from en croachmen t .

A sane, decent, civilized society must provide some oasis, some

shelter from public scrutiny, some insulated enclosure, some



24

an d ability t o keep med ical inform at ion pr ivat e.12

To pu t a pat ient’s const itu tional right s in pers pective, cons ider th e

victim and perpetrator of a violent crime. While Miranda allows a

perpetrator to retreat into a “private enclave,” ACA appears to prevent a

victim-patient from totally remaining silent by compelling the victim-

pat ient to disclose cert ain privat e inform at ion. The victim -pat ient’s

privat e encla ve is th ereby compr omised. The victim-pat ient is put in a

worse position t ha n his or her alleged a tt acker.

II. ACA IS U NCONSTITU TIONAL BECAUSE SE CTION 1501 IS

NOT S EVERABLE

The t ra ditiona l test for severability is well-kn own:

“The standard for determining the severability of an

unconstitutional provision is well established: Unless it is evident

that the Legislature would not have enacted those provisions which

are within its power, independently of that which is not, the invalid

part may be dropped if what is left is fully operative as a law.”

Alask a A irlines v. Brock , 480 U.S. 678, 684 (1987)(int ernal quot at ion

marks omitted). While the Act itself contains no statement of

whether its provisions are severable, “[i]n the absence of a

12

The risk of loss of pr ivat e in form a tion is real. Today, ma ny privat einsurers, federal agencies and their respective business associates

out sour ce at least par t of their opera t ions. GAO, PRIVACY: Domest ic an d

Offshore Out sourcing of Persona l Inform at ion in Medicar e, Medicaid, an d

TRICARE, Report No. 06-676 (Sept. 2006). Therefore, a patient has little

actual knowledge or control over who sees his or her confidential

information.



25

severability clause,… Congress’ silence is just that – silence – and

does not r aise a presu mpt ion a gainst s evera bility.” Id. at 686….

New Y ork v . U.S ., 505 U.S. 144, 186 (1992). Nor, as a m at t er of logic and

judicial consistency, should that Congressional silence raise a

presu m ption in favor of severability.

The Secretary is prevented from arguing that Section 1501 is

severable if it is unconstitutional because she repeatedly admitted that

the individua l ma nda te is “essen tia l” t o ACA. Defenda nt ’s Motion for

Summary Judgment , Virginia Action Doc 91 a t 1, 13-16, 25-29; Or der

Grant ing Summary Judgment , Florida Action Doc 150 at 63-64 (“the

defendants concede that [the individual mandate] is absolutely necessary

for t he Act’s insu r an ce ma rk et r efor ms t o work as inten ded. In fact, they

refer to it as an ‘essent ial’ par t of th e Act at least four teen times in th eir

mot ion to dism iss”); Brief for Appellant , Virginia Appeal, Doc 21 at 34-39;

Clarification Order at 6-8.

Furthermore, neither Section 1501 nor any other unconstitutional

provision in ACA may be severed to save the remainder of ACA because

severa nce is a judicia l line item veto. In Clinton, Presidential line item

vetoes were declared unconstitutional. 524 U.S. at 447-449. In Chadha,

Congress ional vetoes were declar ed unconst itut iona l. 462 U.S. at 959.



26

Although the U.S. Supreme Court has, on occasion, severed defective

provisions of federal statutes, see e.g., Alaska Airlines , 480 U.S.678, that

remedy should be unavailable to courts in light of Clinton and Chadha.

The Bicamera l and P resentment Clauses require the House and Senat e to

pass pr ecisely t he sam e text – not a single word or pun ctu at ion m ay vary

between the bills passed by each chamber. Clinton, 524 U.S. at 448. The

judiciary, like the President, has no power to rewrite a statute.

Fu rt herm ore, th e idea t ha t t he judiciary be joined wit h t he execut ive in a

“coun cil of r evision” was cons idered a nd expressly rejected by th e Dra ft ers

of the Constitution. Brief of Senators Robert C. Byrd, Daniel Patrick

Moynihan, a nd Ca rl Levin as Am ici Curiae in S up port of Appellees 9-10 in

Clinton v. City of N ew Y ork (Docket No. 97-1374).

In a ddition t o violat ing the Const itu tion’s lett er a nd s pirit, the

practice of severing a defective provision from a statute lacking a

severability clause is bad policy because: (1) it facilitates legislative

sloppin ess – a bill’s au t hor knows th e const itu t iona lity of its pr ovisions

will be addressed piecemeal; (2) it allows judicial activism - a court can

substitut e its own judgment for t he legislative bargain t ha t was st r uck in



27

Congress an d agreed to by the Pr esident;13 an d (3) it encour ages omnibus

legislation – which members of Congress may not have sufficient time to

read a nd u nderst an d prior t o cast ing their votes.14

Regardless of the deference accorded to Congress, this Court may

not sever a defective provision from a statute in the absence of a

severa bility claus e beca use severa nce is a judicial line item veto. This

pra ctice subst a nt ially a lters t he disper sion of powers incorpor at ed into the

Const itut ion. It is time to ret ur n “all legislat ive power” to Congress as

requir ed by th e Cons tit ut ion’s fir st clau se. U.S. CONST. ar t. I, sec. 1, cl. 1.

13 Congress, like other legislatures, is an institution that is conducive to

vote trading and log-rolling activities. To enact a law, a majority coalition

mu st be form ed. Consequen tly, mem bers of Congress often coopera te to

fur th er a n in dividual or collective agenda . Pas sa ge of a bill might requ ire

th e vote of a s ingle mem ber of Congr ess or Sena tor. If ACA had cont ained

a severability clause, the legislative bargain made by members of Congress pr oba bly would not have been rea ched. In deed, a severa bility

clause was included in an early version of H.R. 3590, but was excluded

from ACA, as enacted .

14 The Presentment Clause directs “reconsideration” of vetoed bills -

implicitly requ iring mem bers of Congress t o actu a lly “cons ider” a bill.



CERTIF ICATE OF SE RVICE

This is to certify that on April 4, 2011, I electronically filed the

foregoing Brief of Association of American Physicians and Surgeons, Inc.,

J an is Chester, M.D., Mark J . Hau ser, M.D., Guenter L. Spa nk nebel, M.D.

and Graham L. Spruiell, M.D., as Amici Curiae in Support of

Appellee/Cross-Appellant with the Clerk of the Court using the CM/ECF

System. I certify tha t a ll par ties in t his case ar e registered CM/ECF users

an d th at service will be accom plished by the CM/ECF syst em.

s/ Andr ew L. Schlafly

At torney for Am ici Curiae

Amicus Brief in Support of Virginia - Cuccinelli Lawsuit Against Obama Care - Fourth Circuit

Documents

Transcript of Amicus Brief in Support of Virginia - Cuccinelli Lawsuit Against Obama Care - Fourth Circuit