ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MICHELE NORRIS, host:

And I'm Michele Norris.

A federal judge in Pensacola, Florida, has ruled that the health care overhaul law is unconstitutional. The judge said that requiring people to buy health insurance goes beyond the powers given to Congress by the Constitution. And he took that issue one step further than most people had expected. He said the entire law is invalid.

With us now to explain what this means is NPR health policy correspondent Julie Rovner. First of all, Julie, exactly what did the judge in this case decide?

JULIE ROVNER: Well, Federal District Court Judge Roger Vinson actually had two issues before him: first, whether the requirements that states expand the Medicaid program for the poor are coercive; and second whether the mandate to buy health insurance is unconstitutional.

Now, he actually rejected the Medicaid claim, threw that out, which ironically is the one that the 26 states we keep hearing so much about were suing over.

The states actually tried to sue on the second part, that mandate to buy insurance, but all but two of them got kicked out of that. The remaining plaintiffs, which were two individuals and the National Federation of Independent Business, stayed in, and they ultimately prevailed, successfully arguing that the mandate is indeed unconstitutional.

NORRIS: But he didn't stop with the insurance mandate. He said the entire law must be declared invalid. What was his reasoning there?

ROVNER: Well, this is the part that's raising a lot of eyebrows. This is the fourth case so far that's reached this point. Two district court judges have found the law is constitutional. And the one other judge who said the individual requirement is not constitutional just said that part should be eliminated, that the rest of the law should be allowed to proceed without it.

That's what's known in legal jargon as severability. And the general rule for judges is that when they find a part of a law unconstitutional, they're supposed to preserve as much of the rest of the law as they can.

Now, Judge Vinson acknowledged that in his decision. Then he went on in several pages to say he thought Congress would rather have no law than a law without this individual requirement. In fact he wrote, and I quote: "The individual mandate and the remaining provisions are all inextricably bound together in purposes and must stand or fall as a single unit." And in that case he decided they all must fall.

NORRIS: So Julie, what happens now?

ROVNER: Well, that's not entirely clear. The Justice department will appeal the case, as it's appealing the other decision against the law in Virginia. And the judge didn't issue an injunction that would clearly block implementation.

So it's not certain what this decision means for implementation of the law going forward. The Justice Department did issue a statement saying it's looking at all of its options, including asking for a stay of the ruling while the case is on appeal.

Meanwhile, the next step for all of these cases obviously are appeals courts and, likely, eventually, the Supreme Court, which will make the ultimate ruling about the constitutionality of this.

NORRIS: One last, quick question, Julie: Is there any question about the politics of the judge in this case, as there was in Virginia?

ROVNER: Well, there was some question about this case, that there was some forum-shopping by the people who were opposed to this. They did go to a place where they thought the judge would be on their side, and, indeed, this judge was.

NORRIS: Thank you, Julie.

ROVNER: You're welcome, Michele.

NORRIS: That's NPR health policy correspondent Julie Rovner.

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