Filed: Sep. 08, 2011
Latest Update: Feb. 22, 2020
Summary: PUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 11-1057 COMMONWEALTH OF VIRGINIA ex rel. KENNETH T. CUCCINELLI, II, in his official capacity as Attorney General of Virginia, Plaintiff - Appellee, v. KATHLEEN SEBELIUS, Secretary of the Department of Health and Human Services, in her official capacity, Defendant – Appellant. ------------------------------ AMERICA'S HEALTH INSURANCE PLANS; CHAMBER OF COMMERCE OF THE UNITED STATES OF AMERICA, Amici Curiae, AMERICAN ASSOCIATION OF
Summary: PUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 11-1057 COMMONWEALTH OF VIRGINIA ex rel. KENNETH T. CUCCINELLI, II, in his official capacity as Attorney General of Virginia, Plaintiff - Appellee, v. KATHLEEN SEBELIUS, Secretary of the Department of Health and Human Services, in her official capacity, Defendant – Appellant. ------------------------------ AMERICA'S HEALTH INSURANCE PLANS; CHAMBER OF COMMERCE OF THE UNITED STATES OF AMERICA, Amici Curiae, AMERICAN ASSOCIATION OF ..
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PUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 11-1057
COMMONWEALTH OF VIRGINIA ex rel. KENNETH T. CUCCINELLI, II, in
his official capacity as Attorney General of Virginia,
Plaintiff - Appellee,
v.
KATHLEEN SEBELIUS, Secretary of the Department of Health and
Human Services, in her official capacity,
Defendant – Appellant.
−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−
AMERICA'S HEALTH INSURANCE PLANS; CHAMBER OF COMMERCE OF THE
UNITED STATES OF AMERICA,
Amici Curiae,
AMERICAN ASSOCIATION OF PEOPLE WITH DISABILITIES; THE ARC OF THE
UNITED STATES; BREAST CANCER ACTION; FAMILIES USA; FRIENDS OF
CANCER RESEARCH; MARCH OF DIMES FOUNDATION; MENTAL HEALTH
AMERICA; NATIONAL BREAST CANCER COALITION; NATIONAL ORGANIZATION
FOR RARE DISORDERS; NATIONAL PARTNERSHIP FOR WOMEN AND FAMILIES;
NATIONAL SENIOR CITIZENS LAW CENTER; NATIONAL WOMEN'S HEALTH
NETWORK; THE OVARIAN CANCER NATIONAL ALLIANCE; AMERICAN NURSES
ASSOCIATION; AMERICAN ACADEMY OF PEDIATRICS, INCORPORATED;
AMERICAN MEDICAL STUDENT ASSOCIATION; CENTER FOR AMERICAN
PROGRESS, d/b/a Doctors for America; NATIONAL HISPANIC MEDICAL
ASSOCIATION; NATIONAL PHYSICIANS ALLIANCE; CONSTITUTIONAL LAW
PROFESSORS; YOUNG INVINCIBLES; KEVIN C. WALSH; AMERICAN CANCER
SOCIETY; AMERICAN CANCER SOCIETY CANCER ACTION NETWORK; AMERICAN
DIABETES ASSOCIATION; AMERICAN HEART ASSOCIATION; DR. DAVID
CUTLER, Deputy, Otto Eckstein Professor of Applied Economics,
Harvard University; DR. HENRY AARON, Senior Fellow, Economic
Studies, Bruce and Virginia MacLaury Chair, The Brookings
Institution; DR. GEORGE AKERLOF, Koshland Professor of
Economics, University of California−Berkeley; DR. STUART ALTMAN,
Sol C. Chaikin Professor of National Health Policy, Brandeis
University; DR. KENNETH ARROW, Joan Kenney Professor of
Economics and Professor of Operations Research, Stanford
University; DR. SUSAN ATHEY, Professor of Economics, Harvard
University; DR. LINDA J. BLUMBERG, Senior Fellow, Urban
Institute, Health Policy Center; DR. LEONARD E. BURMAN, Daniel
Patrick Moynihan Professor of Public Affairs, The Maxwell
School, Syracuse University; DR. AMITABH CHANDRA, Professor of
Public Policy, Kennedy School of Government, Harvard University;
DR. MICHAEL CHERNEW, Professor, Department of Health Care
Policy, Harvard Medical School; DR. PHILIP COOK, Dr. Philip
Cook, ITT/Sanford Professor of Public Policy, Professor of
Economics, Duke University; DR. MICHAEL T. FRENCH, Professor of
Health Economics, University of Miami; DR. CLAUDIA GOLDIN, Henry
Lee Professor of Economics, Harvard University; DR. TAL GROSS,
Department of Health Policy and Management, Mailman School of
Public Health, Columbia University; DR. JONATHAN GRUBER,
Professor of Economics, MIT; DR. JACK HADLEY, Associate Dean for
Finance and Planning, Professor and Senior Health Services
Researcher, College of Health and Human Services, George Mason
University; DR. VIVIAN HO, Baker Institute Chair in Health
Economics and Professor of Economics, Rice University; DR. JOHN
F. HOLAHAN, Ph. D., Director, Health Policy Research Center, The
Urban Institute; DR. JILL HORWITZ, Professor of Law and − Co
Director of the Program in Law & Economics, University of
Michigan School of Law; DR. LAWRENCE KATZ, Elisabeth Allen
Professor of Economics, Harvard University; DR. GENEVIEVE
KENNEY, Senior Fellow, The Urban Institute; DR. FRANK LEVY, Rose
Professor of Urban Economics, Department of Urban Studies and
Planning, MIT; DR. PETER LINDERT, Distinguished Research
Professor of Economics, University of California, Davis; DR.
ERIC MASKIN, Albert O. Hirschman Professor of Social Science at
the Institute for Advanced Study, Princeton University; DR. ALAN
C. MONHEIT, Professor of Health Economics, School of Public
Health, University of Medicine & Dentistry of New Jersey; DR.
MARILYN MOON, Vice President and Director Health Program,
American Institutes for Research; DR. RICHARD J. MURNANE,
Thompson Professor of Education and Society, Harvard University;
DR. JOSEPH P. NEWHOUSE, John D. MacArthur Professor of Health
Policy and Management, Harvard University; DR. LEN M. NICHOLS,
George Mason University; DR. HAROLD POLLACK, Helen Ross
Professor of Social Service Administration, University of
Chicago; DR. MATTHEW RABIN, Edward G. and Nancy S. Jordan
Professor of Economics, University of CaliforniaBerkeley; DR.
−
JAMES B. REBITZER, Professor of Economics, Management, and
Public Policy, Boston University School of Management; DR.
MICHAEL REICH, Professor of Economics, University of California
2
at Berkeley; DR. THOMAS RICE, Professor, UCLA School of Public
Health; DR. MEREDITH ROSENTHAL, Department of Health Policy and
Management, Harvard School of Public Health; DR. CHRISTOPHER
RUHM, Professor of Public Policy and Economics, University of
Virginia; DR. JONATHAN SKINNER, Professor of Economics,
Dartmouth College, and Professor of Community and Family
Medicine, Dartmouth Medical School; DR. KATHERINE SWARTZ,
Professor, Department of Health Policy and Management, Harvard
School of Public Health; DR. KENNETH WARNER, Dean of the School
of Public Health and Avedis Donabedian Distinguished University
Professor of Public Health, University of Michigan; DR. PAUL N.
VAN DE WATER, Senior Fellow, Center on Budget and Policy
Priorities; DR. STEPHEN ZUCKERMAN, Senior Fellow, The Urban
Institute; JANET COOPER ALEXANDER, Frederick I. Richman
Professor of Law, Stanford Law School; ERWIN CHEMERINSKY,
Founding Dean, University of CaliforniaIrvine School of Law;
−
AMANDA FROST, Professor of Law, American University Washington
College of Law; ANDY HESSICK, Associate Professor of Law,
Arizona State University Sandra Day O’Connor College of Law;
A.E. DICK HOWARD, White Burkett Miller Professor of Law and
Public Affairs, University of Virginia School of Law; JOHN
CALVIN JEFFRIES, JR., David and Mary Harrison Distinguished
Professor of Law, University of Virginia School of Law; JOHANNA
KALB, Assistant Professor, Loyola University New Orleans College
of Law; LUMEN N. MULLIGAN, Professor of Law, University of
Kansas School of Law; EDWARD A. PURCELL, JR., Joseph Solomon
Distinguished Professor of Law, New York Law School; CAPRICE L.
ROBERTS, Professor, Visiting Professor, Catholic University
Columbus School of Law; Professor of Law, University of West
Virginia School of Law; STEPHEN I. VLADECK, Professor of Law,
American University Washington College of Law; HOWARD M.
WASSERMAN, Associate Professor, FIU College of Law; AARP;
COMMONWEALTH OF MASSACHUSETTS; THE NATIONAL WOMEN'S LAW CENTER;
AMERICAN ASSOCIATION OF UNIVERSITY WOMEN; AMERICAN COLLEGE OF
NURSE−MIDWIVES; AMERICAN FEDERATION OF STATE, COUNTY, AND
MUNICIPAL EMPLOYEES; AMERICAN MEDICAL WOMEN'S ASSOCIATION; THE
ASIAN AMERICAN JUSTICE CENTER; ASIAN & PACIFIC ISLANDER AMERICAN
HEALTH FORUM; THE ASIAN PACIFIC AMERICAN LEGAL CENTER; THE BLACK
WOMENS HEALTH IMPERATIVE; THE COALITION OF LABOR UNION WOMEN;
CHILDBIRTH CONNECTION; THE CONNECTICUT WOMEN'S EDUCATION AND
LEGAL FUND; THE FEMINIST MAJORITY FOUNDATION; IBIS REPRODUCTIVE
HEALTH; INSTITUTE OF SCIENCE AND HUMAN VALUES; MARYLAND WOMEN'S
COALITION FOR HEALTH CARE REFORM; MENTAL HEALTH AMERICA;
NATIONAL ASIAN PACIFIC AMERICAN WOMEN'S FORUM; NATIONAL
ASSOCIATION OF SOCIAL WORKERS; NATIONAL COALITION FOR LGBT
HEALTH; NATIONAL COUNCIL OF JEWISH WOMEN; NATIONAL COUNCIL OF
WOMEN'S ORGANIZATIONS; NATIONAL LATINA INSTITUTE FOR
3
REPRODUCTIVE HEALTH; THE NATIONAL RESEARCH CENTER FOR WOMEN &
FAMILIES; OLDER WOMEN'S LEAGUE; PHYSICIANS FOR REPRODUCTIVE
CHOICE AND HEALTH; RAISING WOMEN'S VOICES; SARGENT SHRIVER
NATIONAL CENTER ON POVERTY LAW; SOUTHWEST WOMEN'S LAW CENTER;
WIDER OPPORTUNITIES FOR WOMEN; THE WOMENS LAW CENTER OF
MARYLAND, INCORPORATED; WOMENS LAW PROJECT; VIRGINIA ORGANIZING;
AMERICAN HOSPITAL ASSOCIATION; ASSOCIATION OF AMERICAN MEDICAL
COLLEGES; CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES;
FEDERATION OF AMERICAN HOSPITALS; NATIONAL ASSOCIATION OF
CHILDREN'S HOSPITALS; NATIONAL ASSOCIATION OF PUBLIC HOSPITALS
AND HEALTH SYSTEMS; CONSTITUTIONAL ACCOUNTABILITY CENTER;
MATTHEW H. ADLER, Leon Meltzer Professor of Law, University of
Pennsylvania Law School; REBECCA L. BROWN, Newton Professor of
Constitutional Law, University of Southern California Gould
School of Law; JESSE HERBERT CHOPER, Earl Warren Professor of
Public Law, University of California, Berkeley, School of Law;
MICHAEL C. DORF, Robert S. Stevens Professor of Law, Cornell
University Law School; DANIEL FARBER, Sho Sato Professor of Law,
University of California, Berkeley, School of Law; BARRY
FRIEDMAN, Jacob D. Fuchsberg Professor of Law, New York
University School of Law; WILLIAM P. MARSHALL, Kenan Professor
of Law, University of North Carolina School of Law; GENE NICHOL,
Professor of Law, Director, Center on Poverty, Work &
Opportunity, University of North Carolina School of Law; WILLIAM
J. NOVAK, Professor of Law, The University of Michigan Law
School; RICHARD H. PILDES, Sudler Family Professor of
Constitutional Law, Co−Director, Center on Law and Security, New
York University School of Law; RICHARD A. PRIMUS, Professor of
Law, The University of Michigan Law School; JUDITH RESNIK,
Arthur Liman Professor of Law, Yale Law School; THEODORE W.
RUGAR, Professor of Law, University of Pennsylvania Law School;
ROBERT A. SCHAPIRO, Professor of Law, Emory University School of
Law; DAVID L. SHAPIRO, William Nelson Cromwell Professor,
Emeritus, Harvard Law School; SUZANNA SHERRY, Herman O.
Loewenstein Professor of Law, Vanderbilt University Law School;
NEIL S. SIEGEL, Professor of Law and Political Science, Duke
University School of Law; PETER J. SMITH, Professor of Law,
George Washington University Law School; ADAM WINKLER, Professor
of Law, UCLA School of Law; STATE OF CALIFORNIA; STATE OF
CONNECTICUT; STATE OF DELAWARE; STATE OF HAWAII; STATE OF IOWA;
STATE OF MARYLAND; STATE OF NEW YORK; STATE OF OREGON; STATE OF
VERMONT; CHRISTINE GREGOIRE, Governor of Washington; SERVICE
EMPLOYEES INTERNATIONAL UNION; CHANGE TO WIN,
Amici Supporting Appellant,
4
THE AMERICAN CENTER FOR LAW AND JUSTICE; PAUL BROUN, United
States Representative; ROBERT ADERHOLT, United States
Representative; TODD AKIN, United States Representative; MICHELE
BACHMANN, United States Representative; SPENCER BACHUS, United
States Representative; ROSCOE BARTLETT, United States
Representative; ROB BISHOP, United States Representative; JOHN
BOEHNER, United States Representative; LARRY BUCSHON, United
States Representative; DAN BURTON, United States Representative;
FRANCISCO "QUICO" CANSECO, United States Representative; ERIC
CANTOR, United States Representative; STEVE CHABOT, United
States Representative; MIKE CONAWAY, United States
Representative; BLAKE FARENTHOLD, United States Representative;
JOHN FLEMING, United States Representative; BILL FLORES, United
States Representative; RANDY FORBES, United States
Representative; VIRGINIA FOXX, United States Representative;
TRENT FRANKS, United States Representative; SCOTT GARRETT,
United States Representative; LOUIE GOHMERT, United States
Representative; RALPH HALL, United States Representative; TIM
HUELSKAMP, United States Representative; BILL JOHNSON, United
States Representative; WALTER JONES, United States
Representative; MIKE KELLY, United States Representative; STEVE
KING, United States Representative; JACK KINGSTON, United States
Representative; JOHN KLINE, United States Representative; DOUG
LAMBORN, United States Representative; JEFF LANDRY, United
States Representative; JAMES LANKFORD, United States
Representative; ROBERT LATTA, United States Representative;
DONALD MANZULLO, United States Representative; THADDEUS
MCCOTTER, United States Representative; CATHY MCMORRIS RODGERS,
United States Representative; GARY MILLER, United States
Representative; JEFF MILLER, United States Representative; RANDY
NEUGEBAUER, United States Representative; STEVE PEARCE, United
States Representative; MIKE PENCE, United States Representative;
JOE PITTS, United States Representative; MIKE POMPEO, United
States Representative; SCOTT RIGELL, United States
Representative; PHIL ROE, United States Representative; ED
ROYCE, United States Representative; LAMAR SMITH, United States
Representative; TIM WALBERG, United States Representative; THE
CONSTITUTIONAL COMMITTEE TO CHALLENGE THE PRESIDENT & CONGRESS
ON HEALTH CARE; MATTHEW SISSEL; PACIFIC LEGAL FOUNDATION;
AMERICANS FOR FREE CHOICE IN MEDICINE; AMERICAN PHYSICIANS AND
SURGEONS, INCORPORATED; JANIS CHESTER, MD; MARK J. HAUSER, MD;
GUENTER L. SPANKNEBEL, MD; GRAHAM L. SPRUIELL, MD; WASHINGTON
LEGAL FOUNDATION; CONSTITUTIONAL LAW SCHOLARS; CATO INSTITUTE;
COMPETITIVE ENTERPRISE INSTITUTE; RANDY E. BARNETT, Professor;
JUSTICE AND FREEDOM FUND; KURT ALLEN ROHLFS; MOUNTAIN STATES
LEGAL FOUNDATION; LANDMARK LEGAL FOUNDATION; BOB MARSHALL,
Virginia Delegate; GUN OWNERS OF AMERICA, INCORPORATED; GUN
5
OWNERS FOUNDATION; AMERICAN LIFE LEAGUE, INCORPORATED; INSTITUTE
ON THE CONSTITUTION; THE LINCOLN INSTITUTE FOR RESEARCH AND
EDUCATION; PUBLIC ADVOCATE OF THE UNITED STATES; CONSERVATIVE
LEGAL DEFENSE AND EDUCATION FUND; THE LIBERTY COMMITTEE;
DOWNSIZE DC FOUNDATION; DOWNSIZEDC.ORG; POLICY ANALYSIS CENTER;
FAMILY RESEARCH COUNCIL; WILLIAM BARR, Former United States
Attorney General; EDWIN MEESE, III, Former United States
Attorney General; DICK THORNBURGH, Former United States Attorney
General; CENTER FOR CONSTITUTIONAL JURISPRUDENCE; AMERICAN CIVIL
RIGHTS UNION; PHYSICIAN HOSPITALS OF AMERICA; TOUSSAINT TYSON,
Amici Supporting Appellee.
No. 11-1058
COMMONWEALTH OF VIRGINIA ex rel. KENNETH T. CUCCINELLI, II, in
his official capacity as Attorney General of Virginia,
Plaintiff − Appellant,
v.
KATHLEEN SEBELIUS, Secretary of the Department of Health and
Human Services, in her official capacity,
Defendant – Appellee.
−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−
AMERICA'S HEALTH INSURANCE PLANS; CHAMBER OF COMMERCE OF THE
UNITED STATES OF AMERICA,
Amici Curiae,
AMERICAN ASSOCIATION OF PEOPLE WITH DISABILITIES; THE ARC OF THE
UNITED STATES; BREAST CANCER ACTION; FAMILIES USA; FRIENDS OF
CANCER RESEARCH; MARCH OF DIMES FOUNDATION; MENTAL HEALTH
AMERICA; NATIONAL BREAST CANCER COALITION; NATIONAL ORGANIZATION
FOR RARE DISORDERS; NATIONAL PARTNERSHIP FOR WOMEN AND FAMILIES;
NATIONAL SENIOR CITIZENS LAW CENTER; NATIONAL WOMEN'S HEALTH
NETWORK; THE OVARIAN CANCER NATIONAL ALLIANCE; AMERICAN NURSES
ASSOCIATION; AMERICAN ACADEMY OF PEDIATRICS, INCORPORATED;
AMERICAN MEDICAL STUDENT ASSOCIATION; CENTER FOR AMERICAN
PROGRESS, d/b/a Doctors for America; NATIONAL HISPANIC MEDICAL
6
ASSOCIATION; NATIONAL PHYSICIANS ALLIANCE; CONSTITUTIONAL LAW
PROFESSORS; YOUNG INVINCIBLES; KEVIN C. WALSH; AMERICAN CANCER
SOCIETY; AMERICAN CANCER SOCIETY CANCER ACTION NETWORK; AMERICAN
DIABETES ASSOCIATION; AMERICAN HEART ASSOCIATION; DR. DAVID
CUTLER, Deputy, Otto Eckstein Professor of Applied Economics,
Harvard University; DR. HENRY AARON, Senior Fellow, Economic
Studies, Bruce and Virginia MacLaury Chair, The Brookings
Institution; DR. GEORGE AKERLOF, Koshland Professor of
Economics, University of California −Berkeley; DR. STUART ALTMAN,
Sol C. Chaikin Professor of National Health Policy, Brandeis
University; DR. KENNETH ARROW, Joan Kenney Professor of
Economics and Professor of Operations Research, Stanford
University; DR. SUSAN ATHEY, Professor of Economics, Harvard
University; DR. LINDA J. BLUMBERG, Senior Fellow, Urban
Institute, Health Policy Center; DR. LEONARD E. BURMAN, Daniel
Patrick Moynihan Professor of Public Affairs, The Maxwell
School, Syracuse University; DR. AMITABH CHANDRA, Professor of
Public Policy, Kennedy School of Government, Harvard University;
DR. MICHAEL CHERNEW, Professor, Department of Health Care
Policy, Harvard Medical School; DR. PHILIP COOK, Dr. Philip
Cook, ITT/Sanford Professor of Public Policy, Professor of
Economics, Duke University; DR. MICHAEL T. FRENCH, Professor of
Health Economics, University of Miami; DR. CLAUDIA GOLDIN, Henry
Lee Professor of Economics, Harvard University; DR. TAL GROSS,
Department of Health Policy and Management, Mailman School of
Public Health, Columbia University; DR. JONATHAN GRUBER,
Professor of Economics, MIT; DR. JACK HADLEY, Associate Dean for
Finance and Planning, Professor and Senior Health Services
Researcher, College of Health and Human Services, George Mason
University; DR. VIVIAN HO, Baker Institute Chair in Health
Economics and Professor of Economics, Rice University; DR. JOHN
F. HOLAHAN, Ph. D., Director, Health Policy Research Center, The
Urban Institute; DR. JILL HORWITZ, Professor of Law and Co −
Director of the Program in Law & Economics, University of
Michigan School of Law; DR. LAWRENCE KATZ, Elisabeth Allen
Professor of Economics, Harvard University; DR. GENEVIEVE
KENNEY, Senior Fellow, The Urban Institute; DR. FRANK LEVY, Rose
Professor of Urban Economics, Department of Urban Studies and
Planning, MIT; DR. PETER LINDERT, Distinguished Research
Professor of Economics, University of California, Davis; DR.
ERIC MASKIN, Albert O. Hirschman Professor of Social Science at
the Institute for Advanced Study, Princeton University; DR. ALAN
C. MONHEIT, Professor of Health Economics, School of Public
Health, University of Medicine & Dentistry of New Jersey; DR.
MARILYN MOON, Vice President and Director Health Program,
American Institutes for Research; DR. RICHARD J. MURNANE,
Thompson Professor of Education and Society, Harvard University;
7
DR. JOSEPH P. NEWHOUSE, John D. MacArthur Professor of Health
Policy and Management, Harvard University; DR. LEN M. NICHOLS,
George Mason University; DR. HAROLD POLLACK, Helen Ross
Professor of Social Service Administration, University of
Chicago; DR. MATTHEW RABIN, Edward G. and Nancy S. Jordan
Professor of Economics, University of CaliforniaBerkeley; DR.
−
JAMES B. REBITZER, Professor of Economics, Management, and
Public Policy, Boston University School of Management; DR.
MICHAEL REICH, Professor of Economics, University of California
at Berkeley; DR. THOMAS RICE, Professor, UCLA School of Public
Health; DR. MEREDITH ROSENTHAL, Department of Health Policy and
Management, Harvard School of Public Health; DR. CHRISTOPHER
RUHM, Professor of Public Policy and Economics, University of
Virginia; DR. JONATHAN SKINNER, Professor of Economics,
Dartmouth College, and Professor of Community and Family
Medicine, Dartmouth Medical School; DR. KATHERINE SWARTZ,
Professor, Department of Health Policy and Management, Harvard
School of Public Health; DR. KENNETH WARNER, Dean of the School
of Public Health and Avedis Donabedian Distinguished University
Professor of Public Health, University of Michigan; DR. PAUL N.
VAN DE WATER, Senior Fellow, Center on Budget and Policy
Priorities; DR. STEPHEN ZUCKERMAN, Senior Fellow, The Urban
Institute; JANET COOPER ALEXANDER, Frederick I. Richman
Professor of Law, Stanford Law School; ERWIN CHEMERINSKY,
Founding Dean, University of California −Irvine School of Law;
AMANDA FROST, Professor of Law, American University Washington
College of Law; ANDY HESSICK, Associate Professor of Law,
Arizona State University Sandra Day O’Connor College of Law;
A.E. DICK HOWARD, White Burkett Miller Professor of Law and
Public Affairs, University of Virginia School of Law; JOHN
CALVIN JEFFRIES, JR., David and Mary Harrison Distinguished
Professor of Law, University of Virginia School of Law; JOHANNA
KALB, Assistant Professor, Loyola University New Orleans College
of Law; LUMEN N. MULLIGAN, Professor of Law, University of
Kansas School of Law; EDWARD A. PURCELL, JR., Joseph Solomon
Distinguished Professor of Law, New York Law School; CAPRICE L.
ROBERTS, Professor, Visiting Professor, Catholic University
Columbus School of Law; Professor of Law, University of West
Virginia School of Law; STEPHEN I. VLADECK, Professor of Law,
American University Washington College of Law; HOWARD M.
WASSERMAN, Associate Professor, FIU College of Law; AARP;
COMMONWEALTH OF MASSACHUSETTS; THE NATIONAL WOMEN'S LAW CENTER;
AMERICAN ASSOCIATION OF UNIVERSITY WOMEN; AMERICAN COLLEGE OF
NURSE−MIDWIVES; AMERICAN FEDERATION OF STATE, COUNTY, AND
MUNICIPAL EMPLOYEES; AMERICAN MEDICAL WOMEN'S ASSOCIATION; THE
ASIAN AMERICAN JUSTICE CENTER; ASIAN & PACIFIC ISLANDER AMERICAN
HEALTH FORUM; THE ASIAN PACIFIC AMERICAN LEGAL CENTER; THE BLACK
8
WOMENS HEALTH IMPERATIVE; THE COALITION OF LABOR UNION WOMEN;
CHILDBIRTH CONNECTION; THE CONNECTICUT WOMEN'S EDUCATION AND
LEGAL FUND; THE FEMINIST MAJORITY FOUNDATION; IBIS REPRODUCTIVE
HEALTH; INSTITUTE OF SCIENCE AND HUMAN VALUES; MARYLAND WOMEN'S
COALITION FOR HEALTH CARE REFORM; MENTAL HEALTH AMERICA;
NATIONAL ASIAN PACIFIC AMERICAN WOMEN'S FORUM; NATIONAL
ASSOCIATION OF SOCIAL WORKERS; NATIONAL COALITION FOR LGBT
HEALTH; NATIONAL COUNCIL OF JEWISH WOMEN; NATIONAL COUNCIL OF
WOMEN'S ORGANIZATIONS; NATIONAL LATINA INSTITUTE FOR
REPRODUCTIVE HEALTH; THE NATIONAL RESEARCH CENTER FOR WOMEN &
FAMILIES; OLDER WOMEN'S LEAGUE; PHYSICIANS FOR REPRODUCTIVE
CHOICE AND HEALTH; RAISING WOMEN'S VOICES; SARGENT SHRIVER
NATIONAL CENTER ON POVERTY LAW; SOUTHWEST WOMEN'S LAW CENTER;
WIDER OPPORTUNITIES FOR WOMEN; THE WOMENS LAW CENTER OF
MARYLAND, INCORPORATED; WOMENS LAW PROJECT; VIRGINIA ORGANIZING;
AMERICAN HOSPITAL ASSOCIATION; ASSOCIATION OF AMERICAN MEDICAL
COLLEGES; CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES;
FEDERATION OF AMERICAN HOSPITALS; NATIONAL ASSOCIATION OF
CHILDREN'S HOSPITALS; NATIONAL ASSOCIATION OF PUBLIC HOSPITALS
AND HEALTH SYSTEMS; CONSTITUTIONAL ACCOUNTABILITY CENTER;
MATTHEW H. ADLER, Leon Meltzer Professor of Law, University of
Pennsylvania Law School; REBECCA L. BROWN, Newton Professor of
Constitutional Law, University of Southern California Gould
School of Law; JESSE HERBERT CHOPER, Earl Warren Professor of
Public Law, University of California, Berkeley, School of Law;
MICHAEL C. DORF, Robert S. Stevens Professor of Law, Cornell
University Law School; DANIEL FARBER, Sho Sato Professor of Law,
University of California, Berkeley, School of Law; BARRY
FRIEDMAN, Jacob D. Fuchsberg Professor of Law, New York
University School of Law; WILLIAM P. MARSHALL, Kenan Professor
of Law, University of North Carolina School of Law; GENE NICHOL,
Professor of Law, Director, Center on Poverty, Work &
Opportunity, University of North Carolina School of Law; WILLIAM
J. NOVAK, Professor of Law, The University of Michigan Law
School; RICHARD H. PILDES, Sudler Family Professor of
Constitutional Law, Co−Director, Center on Law and Security, New
York University School of Law; RICHARD A. PRIMUS, Professor of
Law, The University of Michigan Law School; JUDITH RESNIK,
Arthur Liman Professor of Law, Yale Law School; THEODORE W.
RUGAR, Professor of Law, University of Pennsylvania Law School;
ROBERT A. SCHAPIRO, Professor of Law, Emory University School of
Law; DAVID L. SHAPIRO, William Nelson Cromwell Professor,
Emeritus, Harvard Law School; SUZANNA SHERRY, Herman O.
Loewenstein Professor of Law, Vanderbilt University Law School;
NEIL S. SIEGEL, Professor of Law and Political Science, Duke
University School of Law; PETER J. SMITH, Professor of Law,
George Washington University Law School; ADAM WINKLER, Professor
9
of Law, UCLA School of Law; STATE OF CALIFORNIA; STATE OF
CONNECTICUT; STATE OF DELAWARE; STATE OF HAWAII; STATE OF IOWA;
STATE OF MARYLAND; STATE OF NEW YORK; STATE OF OREGON; STATE OF
VERMONT; CHRISTINE GREGOIRE, Governor of Washington; SERVICE
EMPLOYEES INTERNATIONAL UNION; CHANGE TO WIN,
Amici Supporting Appellee,
THE AMERICAN CENTER FOR LAW AND JUSTICE; PAUL BROUN, United
States Representative; ROBERT ADERHOLT, United States
Representative; TODD AKIN, United States Representative; MICHELE
BACHMANN, United States Representative; SPENCER BACHUS, United
States Representative; ROSCOE BARTLETT, United States
Representative; ROB BISHOP, United States Representative; JOHN
BOEHNER, United States Representative; LARRY BUCSHON, United
States Representative; DAN BURTON, United States Representative;
FRANCISCO "QUICO" CANSECO, United States Representative; ERIC
CANTOR, United States Representative; STEVE CHABOT, United
States Representative; MIKE CONAWAY, United States
Representative; BLAKE FARENTHOLD, United States Representative;
JOHN FLEMING, United States Representative; BILL FLORES, United
States Representative; RANDY FORBES, United States
Representative; VIRGINIA FOXX, United States Representative;
TRENT FRANKS, United States Representative; SCOTT GARRETT,
United States Representative; LOUIE GOHMERT, United States
Representative; RALPH HALL, United States Representative; TIM
HUELSKAMP, United States Representative; BILL JOHNSON, United
States Representative; WALTER JONES, United States
Representative; MIKE KELLY, United States Representative; STEVE
KING, United States Representative; JACK KINGSTON, United States
Representative; JOHN KLINE, United States Representative; DOUG
LAMBORN, United States Representative; JEFF LANDRY, United
States Representative; JAMES LANKFORD, United States
Representative; ROBERT LATTA, United States Representative;
DONALD MANZULLO, United States Representative; THADDEUS
MCCOTTER, United States Representative; CATHY MCMORRIS RODGERS,
United States Representative; GARY MILLER, United States
Representative; JEFF MILLER, United States Representative; RANDY
NEUGEBAUER, United States Representative; STEVE PEARCE, United
States Representative; MIKE PENCE, United States Representative;
JOE PITTS, United States Representative; MIKE POMPEO, United
States Representative; SCOTT RIGELL, United States
Representative; PHIL ROE, United States Representative; ED
ROYCE, United States Representative; LAMAR SMITH, United States
Representative; TIM WALBERG, United States Representative; THE
CONSTITUTIONAL COMMITTEE TO CHALLENGE THE PRESIDENT & CONGRESS
ON HEALTH CARE; MATTHEW SISSEL; PACIFIC LEGAL FOUNDATION;
10
AMERICANS FOR FREE CHOICE IN MEDICINE; AMERICAN PHYSICIANS AND
SURGEONS, INCORPORATED; JANIS CHESTER, MD; MARK J. HAUSER, MD;
GUENTER L. SPANKNEBEL, MD; GRAHAM L. SPRUIELL, MD; WASHINGTON
LEGAL FOUNDATION; CONSTITUTIONAL LAW SCHOLARS; CATO INSTITUTE;
COMPETITIVE ENTERPRISE INSTITUTE; RANDY E. BARNETT, Professor;
JUSTICE AND FREEDOM FUND; KURT ALLEN ROHLFS; MOUNTAIN STATES
LEGAL FOUNDATION; LANDMARK LEGAL FOUNDATION; BOB MARSHALL,
Virginia Delegate; GUN OWNERS OF AMERICA, INCORPORATED; GUN
OWNERS FOUNDATION; AMERICAN LIFE LEAGUE, INCORPORATED; INSTITUTE
ON THE CONSTITUTION; THE LINCOLN INSTITUTE FOR RESEARCH AND
EDUCATION; PUBLIC ADVOCATE OF THE UNITED STATES; CONSERVATIVE
LEGAL DEFENSE AND EDUCATION FUND; THE LIBERTY COMMITTEE;
DOWNSIZE DC FOUNDATION; DOWNSIZEDC.ORG; POLICY ANALYSIS CENTER;
FAMILY RESEARCH COUNCIL; WILLIAM BARR, Former United States
Attorney General; EDWIN MEESE, III, Former United States
Attorney General; DICK THORNBURGH, Former United States Attorney
General; CENTER FOR CONSTITUTIONAL JURISPRUDENCE; AMERICAN CIVIL
RIGHTS UNION; PHYSICIAN HOSPITALS OF AMERICA; TOUSSAINT TYSON,
Amici Supporting Appellant.
Appeal from the United States District Court for the Eastern
District of Virginia, at Richmond. Henry E. Hudson, District
Judge. (3:10-cv-00188-HEH)
Argued: May 10, 2011 Decided: September 8, 2011
Before MOTZ, DAVIS, and WYNN, Circuit Judges.
Vacated and remanded by published opinion. Judge Motz wrote the
opinion, in which Judge Davis and Judge Wynn joined.
ARGUED: Neal Kumar Katyal, UNITED STATES DEPARTMENT OF JUSTICE,
Washington, D.C., for Appellant/Cross-Appellee. Earle Duncan
Getchell, Jr., OFFICE OF THE ATTORNEY GENERAL OF VIRGINIA,
Richmond, Virginia, for Appellee/Cross-Appellant. ON BRIEF:
Tony West, Assistant Attorney General, Beth S. Brinkmann, Deputy
Assistant Attorney General, Mark B. Stern, Alisa B. Klein,
Anisha S. Dasgupta, UNITED STATES DEPARTMENT OF JUSTICE,
Washington, D.C.; Neil H. MacBride, United States Attorney,
Alexandria, Virginia, for Appellant/Cross-Appellee. Kenneth T.
11
Cuccinelli, II, Attorney General of Virginia, Stephen R.
McCullough, Senior Appellate Counsel, Charles E. James, Jr.,
Chief Deputy Attorney General, Wesley G. Russell, Jr., Deputy
Attorney General, OFFICE OF THE ATTORNEY GENERAL OF VIRGINIA,
Richmond, Virginia, for Appellee/Cross-Appellant. Joseph
Miller, Julie Simon Miller, AMERICA’S HEALTH INSURANCE PLANS,
Washington, D.C.; Seth P. Waxman, Randolph D. Moss, Catherine M.
A. Carroll, Madhu Chugh, WILMER CUTLER PICKERING HALE AND DORR
LLP, Washington, D.C., for American’s Health Insurance Plans,
Amicus Curiae. Robin S. Conrad, Shane B. Kawka, NATIONAL
CHAMBER LITIGATION CENTER, INC., Washington, D.C.; K. Lee
Blalack, II, Brian Boyle, Joshua Deahl, O’MELVENY & MYERS LLP,
Washington, D.C., for Chamber of Commerce of the United States
of America, Amicus Curiae. Rochelle Bobroff, Simon Lazarus,
NATIONAL SENIOR CITIZENS LAW CENTER, Washington, D.C., for
American Association of People with Disabilities, The ARC of the
United States, Breast Cancer Action, Families USA, Friends of
Cancer Research, March of Dimes Foundation, Mental Health
America, National Breast Cancer Coalition, National Organization
for Rare Disorders, National Partnership for Women and Families,
National Senior Citizens Law Center, National Women’s Health
Network, and The Ovarian Cancer National Alliance, Amici
Supporting Appellant/Cross-Appellee. Ian Millhiser, CENTER FOR
AMERICAN PROGRESS, Washington, D.C., for American Nurses
Association, American Academy of Pediatrics, Incorporated,
American Medical Student Association, Center for American
Progress, d/b/a Doctors for America, National Hispanic Medical
Association, and National Physicians Alliance, Amici Supporting
Appellant/Cross-Appellee. Gillian E. Metzger, Trevor W.
Morrison, New York, New York; Andrew J. Pincus, Charles A.
Rothfeld, Paul W. Hughes, Michael B. Kimberly, MAYER BROWN LLP,
Washington, D.C., for Constitutional Law Professors, Amici
Supporting Appellant/Cross-Appellee. Brett A. Walter, BAACH
ROBINSON & LEWIS PLLC, Washington, D.C., for Young Invincibles,
Amicus Supporting Appellant/Cross-Appellee. Kevin C. Walsh,
UNIVERSITY OF RICHMOND SCHOOL OF LAW, Richmond, Virginia, for
Kevin C. Walsh, Amicus Supporting Appellant/Cross-Appellee.
Mary P. Rouvelas, Senior Counsel, AMERICAN CANCER SOCIETY,
Washington, D.C.; John Longstreth, Molly Suda, K&L GATES LLP,
Washington, D.C., for American Cancer Society, American Cancer
Society Cancer Action Network, American Diabetes Association,
and American Heart Association, Amici Supporting
Appellant/Cross-Appellee. Richard L. Rosen, ARNOLD & PORTER
LLP, Washington, D.C., for Economic Scholars, Amici Supporting
Appellant/Cross-Appellee. Stephen I. Vladeck, Washington, D.C.;
F. Paul Bland, Jr., CHAVEZ & GERTLER, Washington, D.C., for
Professors of Federal Jurisdiction, Amici Supporting
12
Appellant/Cross-Appellee. Stuart R. Cohen, Stacy Canan, AARP
FOUNDATION LITIGATION; Michael Schuster, AARP, Washington, D.C.,
for AARP, Amicus Supporting Appellant/Cross-Appellee. Martha
Coakley, Attorney General of Massachusetts, Frederick D.
Augenstern, Assistant Attorney General, Thomas M. O’Brien,
Assistant Attorney General, Daniel J. Hammond, Assistant
Attorney General, Boston, Massachusetts, for Commonwealth of
Massachusetts, Amicus Supporting Appellant/Cross-Appellee.
Marcia D. Greenberger, Emily J. Martin, Judith G. Waxman, Lisa
Codispoti, NATIONAL WOMEN’S LAW CENTER; Melissa Hart, UNIVERSITY
OF COLORADO LAW SCHOOL, Boulder, Colorado, for National Women's
Law Center, American Association of University Women, American
College of Nurse-Midwives, Amerian Federation of State, County
and Municipal Employees, American Medical Women's Association,
The Asian American Justice Center, Asian & Pacific Islander
American Health Forum; The Asian Pacific American Legal Center,
Black Women's Health Imperative, The Coalition of Labor Union
Women, Childbirth Connection, The Connecticut Women’s Education
and Legal Fund, The Feminist Majority Foundation, Ibis
Reproductive Health, Institute of Science and Human Values,
Maryland Women's Coalition for Health Care Reform, Mental Health
America, National Asian Pacific American Women's Forum, National
Association of Social Workers, National Coalition for LGBT
Health, National Council of Jewish Women, National Council of
Women's Organizations, National Latina Institute for
Reproductive Health, The National Research Center for Women &
Families, Older Women's League, Physicians for Reproductive
Choice and Health, Raising Women's Voices, Sargent Shriver
National Center on Poverty Law, Southwest Women's Law Center,
Wider Opportunities for Women, The Women's Law Center of
Maryland, Incorporated, and Women's Law Project, Amici
Supporting Appellant/Cross-Appellee. Thomas D. Domonoske,
Harrisonburg, Virginia, for Virginia Organizing, Amicus
Supporting Appellant/Cross-Appellee. Sheree R. Kanner,
Catherine E. Stetson, Dominic F. Perella, Michael D. Kass, Sara
A. Kraner, HOGAN LOVELLS US LLP, Washington, D.C.; Melinda Reid
Hatton, Maureen D. Mudron, AMERICAN HOSPITAL ASSOCIATION,
Washington, D.C.; Ivy Baer, Karen Fisher, ASSOCIATION OF
AMERICAN MEDICAL COLLEGES, Washington, D.C.; Jeffrey G. Micklos,
FEDERATION OF AMERICAN HOSPITALS, Washington, D.C.; Larry S.
Gage, President, NATIONAL ASSOCIATION OF PUBLIC HOSPITALS AND
HEALTH SYSTEMS, Washington, D.C.; Lisa Gilden, Vice President,
General Counsel/Compliance Officer, THE CATHOLIC HEALTH
ASSOCIATION OF THE UNITED STATES, Washington, D.C.; Lawrence A.
McAndrews, President and Chief Executive Officer, NATIONAL
ASSOCIATION OF CHILDREN’S HOSPITALS, Alexandria, Virginia, for
American Hospital Association, Association of American Medical
13
Colleges, Catholic Health Association of the United States,
Federation of American Hospitals, National Association of
Children's Hospitals, and National Association Of Public
Hospitals And Health Systems, Amici Supporting Appellant/Cross-
Appellee. Elizabeth B. Wydra, Douglas T. Kendall,
CONSTITUTIONAL ACCOUNTABILITY CENTER, Washington, D.C., for
Constitutional Accountability Center, Amicus Supporting
Appellant/Cross-Appellee. Barry Friedman, New York, New York;
Jeffrey A. Lamken, Robert K. Kry, Martin V. Totaro, Lucas M.
Walker, Washington, D.C., for Law Professors, Amici Supporting
Appellant/Cross-Appellee. Kamala D. Harris, Attorney General of
California, Manuel M. Medeiros, State Solicitor General, Travis
LeBlanc, Special Assistant Attorney General, Daniel J. Powell,
Deputy Attorney General, San Francisco, California; Douglas F.
Gansler, Attorney General of Maryland, William F. Brockman,
Deputy Solicitor General, Joshua N. Auerbach, Assistant Attorney
General, Baltimore, Maryland; George C. Jespen, Attorney General
of Connecticut, Hartford, Connecticut; Joseph R. Biden, III,
Attorney General of Delaware, Wilmington, Delaware; David M.
Louie, Attorney General of Hawaii, Honolulu, Hawaii; Tom Miller,
Attorney General of Iowa, Des Moines, Iowa; Eric T.
Schneiderman, Attorney General of New York, New York, New York;
John R. Kroger, Attorney General of Oregon, Salem, Oregon;
William H. Sorrell, Attorney General of Vermont, Montpelier,
Vermont, for States of California, Connecticut, Delaware,
Hawaii, Iowa, Maryland, New York, Oregon, and Vermont, Amici
Supporting Appellant/Cross-Appellee. Adam Berger, Kristin
Houser, Rebecca J. Roe, William Rutzick, SCHROETER, GOLDMARK &
BENDER, Seattle, Washington, for Christine O. Gregoire, Governor
of Washington, Amicus Supporting Appellant/Cross-Appellee.
Jonathan Weissglass, Jennifer Sung, P. Casey Pitts, ALTSHULER
BERZON LLP, San Francisco, California, for Service Employees
International Union and Change to Win; Judith A. Scott, Walter
Kamiat, Mark Schneider, Ariel Zev Weisbard, SERVICE EMPLOYEES
INTERNATIONAL UNION, Washington, D.C., Service Employees
International Union; Patrick J. Szymanski, CHANGE TO WIN,
Washington, D.C., for Change to Win, Amici Supporting
Appellant/Cross-Appellee. Jay Alan Sekulow, Stuart J. Roth,
Colby M. May, AMERICAN CENTER FOR LAW & JUSTICE, Washington,
D.C.; John P. Tuskey, Laura B. Hernandez, AMERICAN CENTER FOR
LAW & JUSTICE, Virginia Beach, Virginia, for The American Center
for Law & Justice, Forty-Nine Members of the United States House
of Representatives, and the Constitutional Committee to
Challenge the President & Congress on Health Care, Amici
Supporting Appellee/Cross-Appellant. Robert Luther III, KNICELY
& ASSOCIATES, PC, Williamsburg, Virginia; Timothy Sandefur, Luke
Wake, PACIFIC LEGAL FOUNDATION, Sacramento, California, for
14
Matthew Sissel, Pacific Legal Foundation, and Americans for Free
Choice in Medicine, Amici Supporting Appellee/Cross-Appellant.
David P. Felsher, New York, New York; Andrew L. Schlafly, Far
Hills, New Jersey, for American Physicians and Surgeons,
Incorporated, Janis Chester, M.D., Mark J. Hauser, M.D., Guenter
L. Spanknebel, M.D., and Graham L. Spruiell, M.D., Amici
Supporting Appellee/Cross-Appellant. Ilya Somin, GEORGE MASON
UNIVERSITY SCHOOL OF LAW, Arlington, Virginia; Daniel J. Popeo,
Cory L. Andrews, WASHINGTON LEGAL FOUNDATION, Washington, D.C.,
for Washington Legal Foundation and Constitutional Law Scholars,
Amici Supporting Appellee/Cross-Appellant. Robert A. Levy, Ilya
Shapiro, David H. Rittgers, CATO INSTITUTE, Washington, D.C.;
Patrick M. McSweeney, Powhatan, Virginia; Hans Bader,
COMPETITIVE ENTERPRISE INSTITUTE, Washington, D.C., for Cato
Institute, Competitive Enterprise Institute, and Randy E.
Barnett, Professor, Amici Supporting Appellee/Cross-Appellant.
Deborah J. Dewart, Swansboro, North Carolina, for Justice and
Freedom Fund, Amicus Supporting Appellee/Cross-Appellant. Kurt
Rohlfs, CHERNOFF VILHAUER MCCLUNG & STENZEL, Portland, Oregon,
for Kurt Allen Rohlfs, Amicus Supporting Appellee/Cross-
Appellant. Joel M. Spector, MOUNTAIN STATES LEGAL FOUNDATION,
Lakewood, Colorado, for Mountain States Legal Foundation, Amicus
Supporting Appellee/Cross-Appellant. Mark R. Levin, Michael J.
O’Neill, Matthew C. Forys, LANDMARK LEGAL FOUNDATION, Leesburg,
Virginia; Richard P. Hutchison, LANDMARK LEGAL FOUNDATION,
Kansas City, Missouri, for Landmark Legal Foundation, Amicus
Supporting Appellee/Cross-Appellant. William J. Olson, Herbert
W. Titus, John S. Miles, Jeremiah L. Morgan, WILLIAM J. OLSON,
PC, Vienna, Virginia, for Bob Marshall, Virginia Delegate, Gun
Owners of America, Incorporated, Gun Owners Foundation, American
Life League, Incorporated, Institute on the Constitution, The
Lincoln Institute for Research and Education, Public Advocate of
the United States, Conservative Legal Defense and Education
Fund, The Liberty Committee, Downsize DC Foundation,
Downsizedc.org, and Policy Analysis Center, Amici Supporting
Appellee/Cross-Appellant. Kenneth A. Klukowski, FAMILY RESEARCH
COUNCIL, Washington, D.C., for Family Research Council, Amicus
Supporting Appellee/Cross-Appellant. Michael A. Carvin, C.
Kevin Marshall, JONES DAY, Washington, D.C., for Former United
States Attorneys General William Barr, Edwin Meese, III, and
Dick Thornburgh, Amici Supporting Appellee/Cross-Appellant.
John C. Eastman, Anthony T. Caso, Karen J. Lugo, CHAPMAN
UNIVERSITY SCHOOL OF LAW, Orange, California, for Center for
Constitutional Jurisprudence, Amicus Supporting Appellee/Cross-
Appellant. Peter Ferrara, AMERICAN CIVIL RIGHTS UNION, Easton,
Pennsylvania, for American Civil Rights Union, Amicus Supporting
Appellee/Cross-Appellant. Scott C. Oostdyk, Robert L. Hodges,
15
H. Carter Redd, Lisa M. Sharp, Matthew D. Fender, MCGUIREWOODS
LLP, Richmond, Virginia, for Physician Hospitals of America,
Amicus Supporting Appellee/Cross-Appellant. Toussaint Tyson,
Gainesville, Florida, Amicus Supporting Appellee/Cross-
Appellant.
16
DIANA GRIBBON MOTZ, Circuit Judge:
The Commonwealth of Virginia (“Virginia”) brings this
action against Kathleen Sebelius, the Secretary of the
Department of Health and Human Services (“the Secretary”).
Virginia challenges one provision of the Patient Protection and
Affordable Care Act as an unconstitutional exercise of
congressional power. Virginia maintains that the conflict
between this provision and a newly-enacted Virginia statute
provides it with standing to pursue this action. After finding
that this asserted conflict did give Virginia standing to sue,
the district court declared the challenged provision
unconstitutional. For the reasons that follow, we hold that
Virginia, the sole plaintiff here, lacks standing to bring this
action. Accordingly, we vacate the judgment of the district
court and remand with instructions to dismiss the case for lack
of subject-matter jurisdiction.
I.
In March 2010 Congress enacted the Patient Protection and
Affordable Care Act (“the Affordable Care Act” or “the Act”),
which seeks to institute comprehensive changes in the health
insurance industry. Pub. L. No. 111-148. The provision of the
Act challenged here requires, with limited exceptions, that
individual taxpayers who fail to “maintain” adequate health
17
insurance coverage pay a “penalty.” 26 U.S.C. § 5000A(a)-(b).
We describe the Affordable Care Act and this “individual
mandate” provision in Liberty Univ. v. Geithner, -- F.3d -- (4th
Cir. 2011). We need not repeat that discussion here. Like the
plaintiffs in Liberty, Virginia contends that Congress lacked
constitutional authority to enact the individual mandate.
This case, however, differs from Liberty and every one of
the many other cases challenging the Act in a critical respect:
the sole provision challenged here -- the individual mandate –-
imposes no obligations on the sole plaintiff, Virginia.
Notwithstanding this fact, Virginia maintains that it has
standing to bring this action because the individual mandate
allegedly conflicts with a newly-enacted state statute, the
Virginia Health Care Freedom Act (VHCFA).
Virginia filed this action on March 23, 2010, the same day
that the President signed the Affordable Care Act into law. The
Governor of Virginia did not sign the VHFCA into law until the
next day. The VHCFA declares, with exceptions not relevant
here, that “[n]o resident of this Commonwealth . . . shall be
required to obtain or maintain a policy of individual insurance
coverage.” Va. Code Ann. § 38.2-3430.1:1. It contains no
enforcement mechanism.
Because the individual mandate applies only to individual
persons, not states, the Secretary moved to dismiss the suit for
18
lack of subject-matter jurisdiction. The Secretary contended
that Virginia had not and could not allege any cognizable injury
and so was without standing to bring this action. Virginia
insisted that it acquired standing from the asserted “collision”
between its new statute, the VHCFA, and the individual mandate.
Although the district court recognized that the VHCFA was only
“declaratory [in] nature,” it held that the VHCFA provided
Virginia standing. The court then declared the individual
mandate unconstitutional, awarding summary judgment to Virginia.
The Secretary appeals, maintaining that Virginia lacks
standing to challenge the individual mandate and that, in any
event, the mandate withstands constitutional attack. We review
de novo the district court’s ruling as to standing. See Benham
v. City of Charlotte,
635 F.3d 129, 134 (4th Cir. 2011).
Because we hold that Virginia lacks standing, 1 we cannot reach
the question of whether the Constitution authorizes Congress to
enact the individual mandate. See Steel Co. v. Citizens for a
Better Env’t,
523 U.S. 83, 101-02 (1998).
1
In Liberty, we held that the Anti-Injunction Act (AIA)
barred two taxpayers from bringing a pre-enforcement action
challenging the individual mandate. -- F.3d at ___. Virginia
may well be exempt from the AIA bar. See South Carolina v.
Regan,
465 U.S. 367, 378 (1984). We do not reach this question,
however, because we must dismiss this case for lack of standing.
See Sinochem Intern. Co. v. Malaysia Intern. Shipping Corp.,
549
U.S. 422, 431 (2007) (noting that “a federal court has leeway to
choose among threshold” jurisdictional grounds for dismissing a
case (internal quotation omitted)).
19
II.
Article III of the Constitution confers on federal courts
the power to resolve only “cases” and “controversies.” A
federal court may not pronounce on “questions of law arising
outside” of such “cases and controversies.” Arizona Christian
Sch. Tuition Org. v. Winn, 563 U.S. --- (2011) (slip op. at 5).
To do so “would be inimical to the Constitution’s democratic
character” and would weaken “the public’s confidence in an
unelected but restrained Federal Judiciary.”
Id.
The standing doctrine prevents federal courts from
transgressing this constitutional limit. See Lujan v. Defenders
of Wildlife,
504 U.S. 555, 560 (1992). Thus, to ensure that
there exists the requisite “case” or “controversy,” a plaintiff
must satisfy the three requirements that combine to form the
“irreducible constitutional minimum of standing.”
Id. at 560.
Specifically, a plaintiff must demonstrate that: (1) it
has “suffered an injury in fact”; (2) there exists a “causal
connection between the injury and the conduct complained of”;
and (3) a favorable judicial ruling will “likely” redress that
injury.
Id. (internal quotations omitted). The burden rests
with the party invoking federal jurisdiction, here Virginia, to
“establish[] these elements.”
Id. at 561. Only if Virginia
meets the burden of establishing standing does the Constitution
20
permit a federal court to address the merits of the arguments
presented. See
Steel, 523 U.S. at 101-02.
Standing here turns on whether Virginia has suffered the
necessary “injury in fact.” To satisfy that requirement,
Virginia must demonstrate that the individual mandate in the
Affordable Care Act “inva[des]” its “legally protected
interest,” in a manner that is both “concrete and
particularized” and “actual or imminent.”
Lujan, 504 U.S. at
560 (internal quotations omitted).
We note at the outset that the individual mandate imposes
none of the obligations on Virginia that, in other cases, have
provided a state standing to challenge a federal statute. Thus,
the individual mandate does not directly burden Virginia, cf.
Bowen v. Public Agencies,
477 U.S. 41, 50 n.17 (1986), does not
commandeer Virginia’s enforcement officials, cf. New York v.
United States,
505 U.S. 144 (1992), and does not threaten
Virginia’s sovereign territory, cf. Massachusetts v. EPA,
549
U.S. 497, 519 (2007). Virginia makes no claim to standing on
these bases.
What Virginia maintains is that it has standing to
challenge the individual mandate solely because of the asserted
conflict between that federal statute and the VHCFA. A state
possesses an interest in its “exercise of sovereign power over
individuals and entities within the relevant jurisdiction,”
21
which “involves the power to create and enforce a legal code.”
Alfred L. Snapp & Son, Inc. v. Puerto Rico,
458 U.S. 592, 601
(1982)). A federal statute that hinders a state’s exercise of
this sovereign power to “create and enforce a legal code” at
least arguably inflicts an injury sufficient to provide a state
standing to challenge the federal statute. See Wyoming v.
United States,
539 F.3d 1236, 1242 (10th Cir. 2008); see also
Diamond v. Charles,
476 U.S. 54, 62 (1986) (noting in dicta that
“a State has standing to defend the constitutionality of its
statute” (emphasis added)). Virginia argues that the individual
mandate, in assertedly conflicting with the VHCFA, has caused
Virginia this sort of sovereign injury.
The Secretary contends that Virginia’s claim is not of the
sort recognized in Wyoming. Rather, according to the Secretary,
Virginia actually seeks to litigate as parens patriae by
asserting the rights of its citizens. As the Secretary points
out, such a claim would run afoul of the prohibition against
states suing the United States on behalf of their citizens. See
Snapp, 458 U.S. at 610 n.16; Massachusetts v. Mellon,
262 U.S.
447, 485-86 (1923). This prohibition rests on the recognition
that a state possesses no legitimate interest in protecting its
citizens from the government of the United States. See
Mellon,
262 U.S. at 485-86. With respect to the federal government’s
relationship to individual citizens, “it is the United States,
22
and not the state, which represents [citizens] as parens
patriae.”
Id. at 486. When a state brings a suit seeking to
protect individuals from a federal statute, it usurps this
sovereign prerogative of the federal government and threatens
the “general supremacy of federal law.” Pennsylvania v. Kleppe,
533 F.2d 668, 677 (D.C. Cir. 1976). A state has no interest in
the rights of its individual citizens sufficient to justify such
an invasion of federal sovereignty. See
id. at 677-78 (noting
that the “federalism interest” in “avoidance of state inference
with the exercise of federal powers” will “predominate and bar”
any parens patriae lawsuit against the United States).
Accordingly, the question presented here is whether the
purported conflict between the individual mandate and the VHCFA
actually inflicts a sovereign injury on Virginia. If it does,
then Virginia may well possess standing to challenge the
individual mandate. But if the VHCFA serves merely as a
smokescreen for Virginia’s attempted vindication of its
citizens’ interests, then settled precedent bars this action.
III.
Faithful application of the above principles mandates a
single answer to this question: the VHFCA does not confer on
Virginia a sovereign interest in challenging the individual
mandate. Virginia lacks standing to challenge the individual
23
mandate because the mandate threatens no interest in the
“enforceability” of the VHCFA. Maine v. Taylor,
477 U.S. 131,
137 (1986).
Contrary to Virginia’s arguments, the mere existence of a
state law like the VHCFA does not license a state to mount a
judicial challenge to any federal statute with which the state
law assertedly conflicts. Rather, only when a federal law
interferes with a state’s exercise of its sovereign “power to
create and enforce a legal code” does it inflict on the state
the requisite injury-in-fact.
Snapp, 458 U.S. at 601 (emphasis
added); see also Franchise Tax Bd. v. Constr. Laborers Vacation
Trust,
463 U.S. 1, 21 (1983) (holding that “federal courts
should not entertain suits by the States to declare the validity
of their regulations despite possibly conflicting federal law”).
Thus, in each case relied on by Virginia, in which a state
was found to possess sovereign standing, the state statute at
issue regulated behavior or provided for the administration of a
state program. See
Taylor, 477 U.S. at 132-33 (regulating
importation of baitfish);
Diamond, 476 U.S. at 59-60 (regulating
abortion);
Wyoming, 539 F.3d at 1239-40 (establishing “procedure
to expunge convictions of domestic violence misdemeanors” for
purposes of “restoring any firearm rights”); Texas Office of
Pub. Util. Counsel v. FCC,
183 F.3d 393, 409 (5th Cir. 1999)
(establishing telecommunications aid programs for schools and
24
libraries); Alaska v. U.S. Dep’t of Transp.,
868 F.2d 441, 442-
43 (D.C. Cir. 1989) (regulating airline price advertising); Ohio
v. U.S. Dep’t of Transp.,
766 F.2d 228, 230 (6th Cir. 1985)
(regulating shipment of hazardous nuclear materials). The state
statutes in each of these cases reflect the “exercise of [a
state’s] sovereign power over individuals and entities within
the relevant jurisdiction.”
Snapp, 458 U.S. at 601.
By contrast, the VHCFA regulates nothing and provides for
the administration of no state program. Instead, it simply
purports to immunize Virginia citizens from federal law. In
doing so, the VHCFA reflects no exercise of “sovereign power,”
for Virginia lacks the sovereign authority to nullify federal
law. See Mayo v. United States,
319 U.S. 441, 445 (1943)
(stating the “corollary” of the Supremacy Clause that “the
activities of the Federal Government are free from regulation by
any state”); Johnson v. Maryland,
254 U.S. 51, 55-56 (1920)
(noting the “entire absence of power on the part of the States
to touch . . . the instrumentalities of the United States”).
Moreover, the individual mandate does not affect Virginia’s
ability to enforce the VHCFA. Rather, the Constitution itself
withholds from Virginia the power to enforce the VHCFA against
the federal government. See Ohio v. Thomas,
173 U.S. 276, 283
(1899) (stating that “federal officers who are discharging their
duties in a state . . . are not subject to the jurisdiction of
25
the state”). Given this fact, the VHCFA merely declares,
without legal effect, that the federal government cannot apply
insurance mandates to Virginia’s citizens. This non-binding
declaration does not create any genuine conflict with the
individual mandate, and thus creates no sovereign interest
capable of producing injury-in-fact.
Nor do we find at all persuasive Virginia’s contention that
the use of the passive voice in the VHCFA -- i.e., a declaration
that no Virginia resident “shall be required” to maintain
insurance –- provides a regulation of private employers and
localities that conflicts with the individual mandate. This is
so because the individual mandate regulates only individuals; it
does not in any way regulate private employers or localities.
See 26 U.S.C. § 5000A(a). Thus, Virginia has suffered no injury
to its sovereign interest in regulating employers and
localities. 2
2
Moreover, even if the individual mandate did some day in
the future interfere with the asserted application of the VHCFA
to localities and private employers, it would not now provide
Virginia standing. Only injury that is “actual or imminent, not
conjectural or hypothetical” can support Article III standing.
Lujan, 504 U.S. at 560 (internal quotation omitted). Any future
conflict between the individual mandate and the purported
regulation of localities or private employers contained in the
VHCFA is at best conjectural. Virginia has identified no actual
non-federal insurance requirement that runs afoul of the VHCFA,
nor has it offered evidence that any private employer or
locality is contemplating the imposition of such a requirement.
26
In sum, Virginia does not possess a concrete interest in
the “continued enforceability” of the VHCFA,
Taylor, 477 U.S. at
137, because it has not identified any plausible, much less
imminent, enforcement of the VHCFA that might conflict with the
individual mandate. Rather, the only apparent function of the
VHCFA is to declare Virginia's opposition to a federal insurance
mandate. And, in fact, the timing of the VHCFA, along with the
statements accompanying its passage, make clear that Virginia
officials enacted the statute for precisely this declaratory
purpose. See Va. Governor’s Message (Mar. 24, 2010) (Governor
stating at VHCFA signing ceremony that “access to quality health
care . . . should not be accomplished through an unprecedented
federal mandate”);
id. (Lieutenant Governor also remarking that
the VHCFA “sent a strong message that we want no part of this
national fiasco”). While this declaration surely announces the
genuine opposition of a majority of Virginia’s leadership to the
individual mandate, it fails to create any sovereign interest in
the judicial invalidation of that mandate. See
Diamond, 476
U.S. at 62 (“The presence of a disagreement, however sharp and
acrimonious it may be, is insufficient by itself to meet Art.
III’s requirements.”).
Given that the VHCFA does nothing more than announce an
unenforceable policy goal of protecting Virginia’s residents
from federal insurance requirements, Virginia's “real interest”
27
is not in the VHCFA itself, but rather in achieving this
underlying goal.
Snapp, 458 U.S. at 600; see
id. at 602 (noting
that “[i]nterests of private parties are obviously not in
themselves sovereign interests, and they do not become such
simply by virtue of the State’s aiding in their achievement”).
But a state may not litigate in federal court to protect its
residents “from the operation of [a] federal statute[],” Georgia
v. Pa. R. Co.,
324 U.S. 439, 447 (1945), nor can it escape this
bar merely by codifying its objection to the federal statute in
question. See New Jersey v. Sargent,
269 U.S. 328, 334 (1926)
(dismissing an action whose “real purpose” was “to obtain a
judicial declaration that . . . Congress exceeded its own
authority”).
The presence of the VHCFA neither lessens the threat to
federalism posed by this sort of lawsuit nor provides Virginia
any countervailing interest in asserting the rights of its
citizens. Cf.
Kleppe, 533 F.2d at 677. After all, the action
of a state legislature cannot render an improper state parens
patriae lawsuit less invasive of federal sovereignty. See
Mellon, 262 U.S. at 485-86 (emphasizing that “it is no part of
[a state’s] duty or power to enforce [its citizens’] rights in
respect of their relations with the federal government”). Nor
does a state acquire some special stake in the relationship
between its citizens and the federal government merely by
28
memorializing its litigation position in a statute. See
Illinois Dep’t of Transp. v. Hinson,
122 F.3d 370, 373 (7th Cir.
1997). To the contrary, the VHCFA, because it is not even
hypothetically enforceable against the federal government,
raises only “abstract questions of political power, of
sovereignty, of government.”
Mellon, 262 U.S. at 485. The
Constitution does not permit a federal court to answer such
questions. See
id. (noting that courts are “without authority
to pass abstract opinions upon the constitutionality of acts of
Congress”).
To permit a state to litigate whenever it enacts a statute
declaring its opposition to federal law, as Virginia has in the
VHCFA, would convert the federal judiciary into a “forum” for
the vindication of a state’s “generalized grievances about the
conduct of government.” Flast v. Cohen,
392 U.S. 88, 106
(1968). Under Virginia’s standing theory, a state could acquire
standing to challenge any federal law merely by enacting a
statute -- even an utterly unenforceable one -- purporting to
prohibit the application of the federal law. For example,
Virginia could enact a statute declaring that “no Virginia
resident shall be required to pay Social Security taxes” and
29
proceed to file a lawsuit challenging the Social Security Act. 3
Or Virginia could enact a statute codifying its constitutional
objection to the CIA’s financial reporting practices and proceed
to litigate the sort of “generalized grievance[]” about federal
administration that the Supreme Court has long held to be
“committed to the . . . political process.” United States v.
Richardson,
418 U.S. 166, 179-80 (1974) (internal quotation
omitted).
Thus, if we were to adopt Virginia’s standing theory, each
state could become a roving constitutional watchdog of sorts; no
issue, no matter how generalized or quintessentially political,
would fall beyond a state’s power to litigate in federal court.
See, e.g., id.; Schlesinger v. Reservists Comm. to Stop the War,
418 U.S. 208, 227 (1974). We cannot accept a theory of standing
that so contravenes settled jurisdictional constraints.
3
At oral argument, Virginia appeared unconcerned about the
prospect of such lawsuits, merely repeating the truism set forth
in its brief that “litigants frequently have standing to lose on
the merits.” Appellee’s Br. at 17. This argument fails. The
Supreme Court has clearly disavowed such “hypothetical
jurisdiction,” emphasizing that jurisdictional requirements are
mandatory in all cases.
Steel, 523 U.S. at 101. The Court has
explained that in cases involving baseless substantive claims,
it is all the more important that we respect the “constitutional
limits set upon courts in our system of separated powers.”
Id.
at 110.
30
IV.
In concluding that Virginia lacks standing to challenge the
individual mandate, we recognize that the question of that
provision’s constitutionality involves issues of unusual legal,
economic, and political significance. The Constitution,
however, requires that courts resolve disputes “not in the
rarified atmosphere of a debating society, but in a concrete
factual context conducive to a realistic appreciation of the
consequences of judicial action.” Valley Forge Christian
College v. Americans United for Separation of Church and State,
Inc.,
454 U.S. 464, 472 (1982). Virginia can provide no such
“concrete factual context” here, because it challenges a
statutory provision that applies not to states, but exclusively
to individuals.
Given this fact, Virginia lacks the “personal stake” in
this case essential to “assure that concrete adverseness which
sharpens the presentation of issues.” Massachusetts v.
EPA, 549
U.S. at 517 (quoting Baker v. Carr,
369 U.S. 186, 204 (1962)).
Thus, Virginia’s litigation approach might well diverge from
that of an individual to whom the challenged mandate actually
does apply. See United States v. Johnson,
319 U.S. 302, 305
(1943) (per curiam) (explaining that the “actual antagonistic
assertion of rights” serves as a “safeguard essential to the
integrity of the judicial process” (internal quotation
31
omitted));
Hinson, 122 F.3d at 373 (noting that rules of
standing aim to prevent state “bureaucrats” and “publicity
seekers” from “wresting control of litigation from the people
directly affected”).
Moreover, the lack of factual context here impedes analysis
of the underlying constitutional disputes. See Comite de Apoyo
a los Trabajadores Agricolas v. U.S. Dep’t of Labor,
995 F.2d
510, 513 (4th Cir. 1993) (explaining that the “concrete
adverseness” required by standing rules “helps reduce the risk
of an erroneous or poorly thought-out decision” (internal
quotation omitted)). For example, both parties premise their
Commerce Clause arguments on their competing characterizations
of what the individual mandate regulates. Compare Appellee’s
Br. at 23 (arguing that § 5000A regulates the “passive status of
being uninsured”) with Appellant’s Br. at 45-48 (arguing that
§ 5000A regulates the financing of consumers’ inevitable
participation in the health care market). A number of factors
might affect the validity of these characterizations, including
a taxpayer’s current possession of health insurance, current or
planned future consumption of health care, or other related
voluntary action. See Thomas More Law Center v. Obama, --- F.3d
--- (6th Cir. 2011) (No. 10-2388, slip op. at 52-53) (opinion of
Sutton, J.). The case at hand lacks the concrete factual
context critical to a proper analysis of these issues.
32
In sum, the significance of the questions at issue here
only heightens the importance of waiting for an appropriate case
to reach the merits. This is not such a case.
V.
For the foregoing reasons, we vacate the judgment of the
district court and remand to that court, with instructions to
dismiss the case for lack of subject-matter jurisdiction.
VACATED AND REMANDED
33