It is the most significant challenge to the law, seen by many as the president’s signature domestic policy achievement.
Judge C. Roger Vinson of the U.S. District Court for the Northern District of Florida overturned the new law in its entirety in January. He argued the individual mandate is unconstitutional -- and that the provisions requiring the individual mandate could not be severed from the rest of the law.
The 25 states joining Florida in this lawsuit are: Arizona, Indiana, Mississippi, Nevada, North Dakota, Alabama, Colorado, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Georgia, Alaska, and -- as of January 19 -- Ohio, Wisconsin, Kansas, Maine, Iowa, and Wyoming. The National Federation of Independent Business and two individuals have also signed on.
"For 220 years, Congress never saw fit to use this particular power," former Solicitor General Paul Clement said on behalf of the states challenging the law.
Neal Kumar Katyal, the acting U.S. Solicitor General who is defending the law from numerous lawsuits around the country, sought to stave off the largest legal challenge to health care reform. As in the Virginia arguments last month, he argued those who choose to go without health insurance are already making economic decisions that affect everyone.
"We are not saying the Congress can force someone to buy something. Our point is that people are already buying this good," Katyal told the three-judge panel. White House Adviser Stephanie Cutter defended the government's position ahead of Wednesday's hearing, writing "the arguments for overturning the Affordable Care Act are simply without merit.
The randomly selected panel includes two appointees of President Bill Clinton -- circuit Judges Frank Hull and Stanley Marcus, while Chief Judge Joel Dubina was tapped by President George H.W. Bush (Dubina’s daughter is Republican Rep. Martha Roby). So far, trial court decisions on the law have broken into judges appointed by Republican presidents ruling against the law and judges appointed by Democrats ruling in favor of it.
Bill Rankin of the Atlanta Journal-Constitution summed up the arguments inside the courtroom:
At the close of the arguments, which lasted about two and a half hours, Chief Judge Joel Dubina called the challenge "a very difficult case" and one that could affect most Americans. He also predicted the U.S. Supreme Court will have the final word on whether the Patient Protection and Affordable Care Act passes constitutional muster.
Dozens of similar cases are currently winding their way through federal courts, but the ruling that comes out of Atlanta could be the strongest indicator yet of whether the ACA will ultimately be allowed to stand.
Last month, a panel of randomly selected judges on the Fourth Circuit – all appointed by Democrats – heard two Virginia challenges to the law in Richmond. The government and Thomas More Law Center argued their cases last week before the Sixth Circuit in Cinncinati. And in July, another appeal will be heard in the Ninth Circuit in California.
Kaiser Health News has put together this scoreboard to help track the legal challenges to the new law.
Legal analysts expect one or more of the pending appeals court cases to eventually reach the Supreme Court for a final determination on the legal challenges.