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

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

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Nos.

11-1057 & 11-1058

IN THE UNITED STATES
COURT OF APPEALS FOR THE FOURTH CIRCUIT

COMMONWEALTH OF VIRGINIA,
ex rel. Kennet h T. Cuccinelli, II, in his
Official Capacit y as At t or ney Gener al of Vir ginia.
Plaint iff-Appellee/Cross-Appellant ,

v.

KATHLEEN SEBELIUS,
Secr et ar y of t he Depar t ment of Healt h
and Human Ser vices, in her Official Capacit y,
Defendant -Appellant /Cross-Appellee.



On Appeal fr om t he Unit ed St at es Dist r ict Cour t
for t he East er n Dist r ict of Vir ginia


BRIEF OF ASSOCIATION OF AMERICAN PHYSICIANS AND
SURGEONS, INC., J ANIS CHESTER, M.D., MARK J . HAUSER, M.D.,
GUENTER L. SPANKNEBEL, M.D., AND GRAHAM L. SPRUIELL,
M.D., AS AMICI CURIAE IN SUPPORT OF APPELLEE/CROSS-
APPELLANT


DAVID P. FELSHER ANDREW L. SCHLAFLY
488 Madison Avenue 939 Old Chest er Rd.
New Yor k, NY 10022 Far Hills, NJ 07931
(212) 308-8505 (908) 719-8608
(212) 308-8582 (fax) (908) 934-9207 (fax)

Apr il 4, 2011 At t or neys for Amici 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 this
information.
_______ 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 is
pursuing 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)
11-1057
April 4, 2011
Andrew L. Schlafly April 4, 2011
Commonwealth of Virginia v. Sebelius
Ass'n of Am. Phys. & Surg. amicus
ì
ì
ì
ì
ì
iii

TABLE OF CONTENTS

Cor por at e Disclosur e St at ement .................................................................... ii
Table of Cont ent s ............................................................................................ iii
Table of Aut hor it ies ........................................................................................ iv
Int er est s of Amici Curiae ................................................................................ 1
Pr eliminar y St at ement ................................................................................... 4
Summar y of Ar gument .................................................................................... 7
Ar gument ......................................................................................................... 8
I. Sect ion 1501 is Unconst it ut ional ........................................................... 8
A. Sect ion 1501 is Not Based on Congr ess’ Power t o Regulat e
Commer ce ................................................................................................. 9

1. The individual mandat e involves no commer ce .................... 10
2. Cour t s may not r ely on Sect ion 1501’s “findings” t o est ablish
Congr essional power under t he Commer ce Clause ............... 13

B. Congr ess May Not Violat e Const it ut ional Const r aint s .................. 15

1. Sect ion 1501 may not be enact ed and amended
simult aneously ......................................................................... 16
2. Congr ess may not invade a pat ient ’s pr ivacy ......................... 20
II. ACA is Unconst it ut ional Because Sect ion 1501 Is Not Sever able ...... 24
Conclusion ...................................................................................................... 28
Cer t ificat e of Compliance .............................................................................. 29

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

iv

TABLE OF AUTHORITIES

CASES

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

Associat ion of American Physicians and S urgeons, Inc. v. Sebelius,
Case No. 1:10-cv-0499-ABJ ................................................................... 2

Clint on v. Cit y of New York , 524 U.S. 417 (1998) .............................. passim

Commonwealt h of Virginia, ex rel. Cuccinelli v. Sebelius, 728 F. Supp. 2d
768 (E.D. Va. 2010), appeals dock et ed, Nos. 11-1057 & 1058 (4t h
Cir .) .............................................................................................. passim

Florida v. Unit ed St at es Depart ment of Healt h and Human Services,
(N.D. Fl.), Case No.: 3:10-cv-91, appeal dock et ed, 11-11021-HH (11t h
Cir .) .............................................................................................. passim

Free Ent er. Fund v. Pub. Co. Account ing Oversight Bd.,
130 S.Ct . 3138 (2010) ............................................................................ 8

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

Immigrat ion and Nat uralizat ion Service v. Chadha,
462 U.S. 919 (1983) .................................................................. 16, 25, 26

Libert y Universit y v. Geit hner, __ F. Supp. 2d __, 2010 WL 4860299 (W.D.
Va. Nov. 30, 2010), appeal dock et ed, No.10-2347 (4t h Cir .) ........... 5, 9

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

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

Mead v. Holder, __ F.Supp.2d ___, 2011 WL 611139 (D.D.C.), appeal
dock et ed, 11-5047 (D.C. Cir .) ............................................................ 5, 9

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


Murphy v. Wat erfront Commission of New York Harbor,
378 U.S. 52 (1964) ................................................................................ 22

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

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

Ok lahoma v. Sebelius, Case No.: 6:11-cv-00030 (E.D. Ok.) ......................... 5

Silverman v. Unit ed St at es, 365 U.S. 505 (1961) ....................................... 22

St enberg v. Carhart , 530 U.S. 914 (2000)...................................................... 1

Tehan v. Unit ed St at es ex rel. S hot t , 382 U.S. 406 (1966)......................... 22

Thomas More Law Cent er v. Obama, 720 F.Supp. 2d 882 (E.D. Mi. 2010),
appeal dock et ed, No. 10-2388 (6t h Cir .) ........................................... 5, 9

Unit ed St at es v. Grunewald, 233 F.2d 556 (2d Cir . 1956),
rev’d, 353 U.S. 391 (1957) ........................................................ 21, 22, 23

Unit ed St at es v. Lopez, 514 U.S. 549 (1995) ............................................... 12

Unit ed St at es v. Morrison, 529 U.S. 598 (2000)............................................ 8

Unit ed St at es v. On Lee, 193 F.2d 306 (2d Cir . 1951),
aff’d, 343 U.S. 747 (1952) ............................................................... 21, 22

Unit ed St at es v. West inghouse Elect ric Corp.,
638 F.2d 570 (3d Cir . 1980) ....................................................... 7, 20, 21

CONSTITUTION


U.S. CONST. ar t . I ........................................................................................ 18

U.S. CONST. ar t . I, sec. 1, cl. 1 .............................................................. 26, 27
vi


U.S. CONST. ar t . I, sec. 7 ............................................................................... 9

U.S. CONST. ar t . I, sec. 7, cl. 2 ........................................................... passim

U.S. CONST. ar t . I, sec. 8 ............................................................................. 10

U.S. CONST. ar t . I, sec. 8, cl. 3 ............................................................ passim

U.S. CONST. ar t . I, sec. 9 ............................................................................... 9

U.S. CONST. ar t . VI ........................................................................................ 6

U.S. CONST. amend. IV ............................................................................... 22

U.S. CONST. amend. V ................................................................................. 22

STATUTES

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

Healt h Car e and Educat ion Reconciliat ion Act of 2010, Pub. L. 111-152,
124 St at . 1029 ................................................................................... 2, 19

Pat ient Pr ot ect ion and Affor dable Car e Act , Pub. L. 111-148,
124 St at . 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

Tit le X ........................................................................................................ 18



CONGRESSIONAL MATERIALS

Br ief of Senat or s Rober t C. Byr d, Daniel Pat r ick Moynihan, and Car l
Levin as Amici Curiae in Suppor t of Appellees 9-10 in Clint on v.
Cit y of New York (Docket No. 97-1374) ............................................. 26

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

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

U.S. Congr ess, Office of Technology Assessment , Prot ect ing Privacy in
Comput erized Medical Informat ion, OTA-TCT-576 (U.S. G.P.O.,
Sept . 1993) ............................................................................................ 20


RULES

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


OTHER AUTHORITIES

Abr aham Lincoln, Speech of J une 16, 1858 (Spr ingfield, Ill.)
reprint ed in Yale Book of Quot at ions 460 (F.R. Shapir o ed.
2006)….................................................................................................. 4

Alber t Einst ein, The Meaning of Relat ivit y (5t h ed. 1956) ........................ 11

Daniel Huff, How t o Lie wit h St at ist ics (1954) ...................................... 14-15

Empir e BlueCr oss/BlueShield For m ENR-02968 (Rev 1/11) ..................... 23

viii

Er nst & Young, LLP, Summary of t he Pat ient Prot ect ion and Affordable
Care Act , incorporat ing The Healt h Care and Educat ion
Reconciliat ion Act (May 2010) ............................................................ 19

Euclid, Element s of Geomet ry (Gr eek Text of J . L. Heiber g (1883-1885))
(R. Fit zpat r ick, ed. & t r anslat or ) ........................................................ 11

GAO, PRIVACY : Domest ic and Offshore Out -sourcing of Personal
Informat ion in Medicare, Medicaid, and TRICARE, Repor t No. 06-
676 (Sept . 2006) .................................................................................... 24

J ames Madison, THE FEDERALIST No. 62 (C. Rossit er , ed. 1961) ......... 18

Michael O. Leavit t , “Healt h r efor m’s cent r al flaw: Too much power in one
office,” Washingt on Post (Febr uar y 18, 2011) .................................... 19

Paul A. Samuelson, Economics (10
t h
ed., 1976) .......................................... 11

1


INTERESTS OF AMICI CURIAE
1

Amici Curiae (“Amici”), which file t his Br ief wit h t he consent of all
t he par t ies, ar e individual physicians

and an associat ion of physicians
having a member ship t hat spans t he nat ion. Amici file t his br ief in
suppor t of t he Commonwealt h of Vir ginia (“The Commonwealt h” or
“Vir ginia") (Appellee/Cr oss-Appellant ) and in opposit ion t o Kat hleen
Sebelius, Secr et ar y of t he Depar t ment of Healt h and Human Ser vices, in
her Official Capacit y (“The Secr et ar y”) (Appellant /Cr oss-Appellee).
Since 1943, Amicus Associat ion of Amer ican Physicians and
Sur geons, Inc. (“AAPS”) has been dedicat ed t o t he highest et hical
st andar ds of t he Oat h of Hippocr at es and t o pr eser ving t he sanct it y of t he
pat ient -physician r elat ionship. AAPS has filed numer ous amicus curiae
br iefs in not ewor t hy cases like t his one. See, e.g, St enberg v. Carhart , 530
U.S. 914 (2000)(cit ing an AAPS amicus br ief). Because AAPS has also
commenced an act ion against The Secr et ar y which cont ains over lapping
allegat ions of unconst it ut ionalit y, t he disposit ion of t hese Appeals may

1
No counsel for a par t y aut hor ed t his br ief in whole or in par t . No per son
or ent it y ot her t han amici curiae or t heir counsel made a monet ar y
cont r ibut ion t o t he pr epar at ion or submission of t his br ief. All par t ies
consent ed t o t he filing of t his Br ief.
2

affect t he r ight s of AAPS and it s member s. Associat ion of American
Physicians and Surgeons, Inc. v. Sebelius, Case No. 1:10-cv-0499-ABJ .
Amicus Guent er L. Spanknebel, M.D., pr ivat ely pr act iced
gast r oent er ology. He is a past pr esident of t he Massachuset t s Medical
Societ y and is cur r ent ly chair of it s Hist or y Commit t ee. He has also
ser ved as a Tr ust ee of t he Healt h Foundat ion of Cent r al Massachuset t s
and on t he facult ies of t he medical schools at Tuft s Univer sit y and t he
Univer sit y of Massachuset t s.
Amicus J anis Chest er , M.D., pr ivat ely pr act ices psychiat r y in
Delawar e, ser ves as chair of t he Depar t ment of Psychiat r y at a
communit y hospit al, is a member of t he facult y at J effer son Medical
College and holds a var iet y of posit ions wit h or ganized medicine and
psychiat r y, locally and nat ionally.
Amicus Mar k J . Hauser , M.D. pr ivat ely pr act ices psychiat r y and
for ensic psychiat r y in Massachuset t s and Connect icut .
Amicus Gr aham Spr uiell, M.D., pr ivat ely pr act ices for ensic
psychiat r y and psychoanalysis in t he Bost on ar ea.
Amici have followed at t empt s in r ecent year s t o enact healt h car e
r efor m legislat ion. As act ive member s of t he medical pr ofession and
3

pur suant t o t heir et hical obligat ions, Amici have car efully st udied t he
int r oduct ion, passage and par t ial ear ly implement at ion of t he Pat ient
Pr ot ect ion and Affor dable Car e Act , Pub. L. 111-148, 124 St at . 119 (2010)
(“ACA”), amended by Healt h Car e and Educat ion Reconciliat ion Act of
2010, Pub. L. 111-152, 124 St at . 1029 (“RA”). Amici have also filed a br ief
in suppor t of The Commonwealt h’s Rule 11 Pet it ion t o t he Unit ed St at es
Supr eme Cour t .
For t he r easons set for t h below, Amici believe ACA is
unconst it ut ional. If upheld, ACA will har m pat ient s and under mine, in
fundament al and danger ous ways, t he pr act ice of medicine. Amici submit
t his br ief in suppor t of The Commonwealt h and ur ge t he Cour t t o affir m
Sect ion 1501’s unconst it ut ionalit y and t o fur t her hold t hat Sect ion 1501 is
not sever able fr om t he r emainder of ACA.

4

PRELIMINARY STATEMENT
ACA has divided our nat ion pr ior t o enact ment , dur ing enact ment
and since enact ment . Cf. Abr aham Lincoln, Speech of J une 16,
1858(Spr ingfield, Ill.) reprint ed in Yale Book of Quot at ions 460 (F.R.
Shapir o ed. 2006)( “[a] house divided against it self cannot st and”).
The Commonwealt h has challenged t he const it ut ionalit y of t he
individual mandat e cont ained in Sect ion 1501 of ACA (“Sect ion 1501”) and
of ACA it self. The Unit ed St at es Dist r ict Cour t for t he East er n Dist r ict of
Vir ginia held Sect ion 1501 is unconst it ut ional and sever able fr om t he
r emainder of ACA and bot h par t ies appealed. Commonwealt h of Virginia,
ex rel. Cuccinelli v. Sebelius, 728 F. Supp. 2d 768 (E.D. Va.
2010)(“Virginia Act ion”), appeals dock et ed, Nos. 11-1057 & 1058 (4t h
Cir .)(“Virginia Appeal”). The Commonwealt h has also filed a Pet it ion for
Wr it of Cer t ior ar i befor e J udgment . Unit ed St at es Supr eme Cour t Docket
No. 10-1014.
2

Besides Vir ginia, t went y-seven ot her st at es have challenged Sect ion
1501’s and ACA’s const it ut ionalit y.

Twent y-six st at es ar e plaint iffs in

2
Pursuant to Rule 11 of the Rules of the Supreme Court.
5

Florida v. Unit ed St at es Depart ment of Healt h and Human Services (N.D.
Fl.), Case No.: 3:10-cv-91(“Florida Act ion”), appeal dock et ed, No. 11-
11021-HH (11
t h
Cir .) (“Florida Appeal”), wher e t he cour t declar ed Sect ion
1501 t o be unconst it ut ional and not sever able fr om t he r emainder of
ACA.
3
Florida Act ion, Doc 151.

Conver sely, in Libert y Universit y v.
Geit hner, __ F. Supp. 2d __, 2010 WL 4860299 (W.D. Va. Nov. 30,
2010)(“Libert y Act ion”), appeal dock et ed, No.10-2347 (4t h Cir .) (“Libert y
Appeal”),
4
Thomas More Law Cent er v. Obama, 720 F.Supp. 2d 882 (E.D.
Mi. 2010)(“TMLC Act ion”), appeal dock et ed, No. 10-2388(6t h Cir .)(“TMLC
Appeal”), and Mead v. Holder, __ F.Supp. 2d ___, 2011 WL 611139
(D.D.C.)(“Mead Act ion”), appeal dock et ed, 11-5047 (D.C. Cir .)(“Mead
Appeal”), t he cour t s found Congr ess has power t o enact Sect ion 1501
under t he Commer ce Clause. In t ot al, mor e t han t went y cases have been
commenced challenging ACA and it s pr ovisions. Plaint iffs/Appellant s
Pet it ion for Init ial En Banc Hear ing, Mead Appeal, at 8 (“Mead En Banc
Pet it ion”).

3
Oklahoma has also commenced a separ at e act ion. Ok lahoma v. Sebelius,
Case No.: 6:11-cv-00030 (E.D. Ok.).
4
The Four t h Cir cuit or der ed t he Virginia Appeal t o be hear d in seriat um
wit h t he Libert y Appeal. Virginia Appeal, Or der dat ed J an. 26, 2011.
6

In addit ion t o Sect ion 1501, Amici believe t hat ACA cont ains scor es
of unconst it ut ional pr ovisions which ar e not sever able fr om t he r emainder
of ACA.
5
It is axiomat ic t hat whenever a st at ut e cont ains any
unconst it ut ional pr ovision t hat is not sever able fr om t he r emainder of t he
st at ut e, no pr ovision of t hat st at ut e may be t r eat ed as t he Supr eme Law
of t he Land pur suant t o Ar t icle VI. U.S. CONST. ar t . VI.
Consequent ly, quickly declar ing ACA unconst it ut ional would
unbur den t he feder al J udiciar y and t he Execut ive Br anch as well as t he
st at es fr om year s of unnecessar y and cost ly lit igat ion. Fur t her mor e unt il
ACA is declar ed unconst it ut ional st at es (including Vir ginia), consumer s,
employer s and ot her s would spend addit ional billions of dollar s t o comply
wit h an unconst it ut ional st at ut e and billions of dollar s will be wit hdr awn
fr om t he Tr easur y based upon an unconst it ut ional law. Vir ginia’s daily
expendit ur es t o comply wit h ACA unquest ionably pr ovide it wit h st anding
t o challenge ACA’s const it ut ionalit y.

5
These pr ovisions, including Sect ion 1501, violat e Ar t icle I, Sect ion 7,
Clause 2 of t he Const it ut ion (“Pr esent ment Clause”) because t hey wer e
simult aneously enact ed and amended. See Sect ion I, B, 1, infra.
Fur t her mor e, t he t est for sever abilit y should be r eexamined because
sever ance of an unconst it ut ional pr ovision fr om a st at ut e lacking a
sever abilit y clause is a judicial line it em vet o, a judicial r emedy which
it self violat es t he Pr esent ment Clause. See Sect ion II, infra.
7

SUMMARY OF ARGUMENT
Amici believe Congr ess lacks power t o enact Sect ion 1501 for t wo
r easons. Fir st , t her e is no power t o r egulat e commer ce because t her e is no
commer ce. See U.S. CONST. ar t . I, sec. 8, cl. 3 (“Commer ce Clause”).
Second, Sect ion 1501 fails t o comply wit h t he Const it ut ion’s pr ocedur al
r equir ement s and subst ant ive r est r ict ions. Pr ocedur ally, Congr ess
violat ed t he Pr esent ment Clause by simult aneously enact ing and
amending Sect ion 1501. Subst ant ively, Sect ion 1501 invades t he “pr ivat e
enclave” enjoyed by pat ient s since t he t ime of Hippocr at es. See Unit ed
St at es v. West inghouse Elect ric Corp., 638 F.2d 570 (3d Cir . 1980);
Miranda v. Arizona, 384 U.S. 436 (1966).
The Secr et ar y’s ar gument t hat Sect ion 1501 is sever able fr om ACA
cannot succeed. Congr ess has declar ed and The Secr et ar y has ar gued
t hat Sect ion 1501 is “essent ial” t o ACA. Fur t her mor e, even if The
Secr et ar y could est ablish Sect ion 1501’s sever abilit y under Alask a
Airlines v. Brock , 480 U.S.678 (1987), sever ance (fr om a st at ut e lacking a
sever abilit y clause) is a judicial line it em vet o t hat t r ansfer s legislat ive
power fr om Congr ess t o t he judiciar y in violat ion of t he Bicamer al and
Pr esent ment Clauses - ignor ing t he pr inciples set for t h in Clint on v. Cit y
8

of New York , 524 U.S. 417 (1998). Sever ance is not , as pr eviously held by
t he U.S. Supr eme Cour t , a doct r ine of judicial r est r aint . Cf. Or der
Gr ant ing Summar y J udgment , Florida Act ion, Doc 150 at 64;
Memor andum Opinion, Virginia Act ion, Doc 161 at 40.
The Cour t obser ved t hat “[s]ever abilit y is a doct r ine of judicial
r est r aint ,” and t hat “just t his past year ,” t he Supr eme Cour t
r eaffir med t hat cour t s should “t r y t o limit t he solut ion t o t he
pr oblem,” sever ing any pr oblemat ic por t ions while leaving t he
r emainder int act ,” and t hat t he nor mal r ule is t hat par t ial
invalidat ion is pr oper . Op. 64 (quot ing Free Ent er. Fund v. Pub. Co.
Account ing Oversight Bd., 130 S.Ct . 3138, 3161 (2010).

Memor andum in Suppor t of Defendant s’ Mot ion t o Clar ify, Florida Act ion,
Doc 156 (“Clarificat ion Mot ion”) at 3. Rat her , sever ance is a doct r ine of
judicial act ivism t hat allows, and possibly even encour ages, const it ut ional
sloppiness by Congr ess and t he Pr esident . In light of Clint on, Amici
suggest Alask a Airlines and it s pr ogeny no longer apply.

ARGUMENT
I. SECTION 1501 IS UNCONSTITUTIONAL
“Ever y law enact ed by Congr ess must be based on one or mor e of it s
power s enumer at ed in t he Const it ut ion.” Unit ed St at es v. Morrison, 529
U.S. 598, 607 (2000); McCulloch v. Maryland, 17 U.S. (4 Wheat .) 316, 405
9

(1819). Those power s ar e const r ained by t he Const it ut ion’s pr ocedur al
r equir ement s, see e.g., U.S. CONST., ar t . I, sec. 7, and subst ant ive
r est r ict ions, see e.g., id. at sec. 9.
A. Sect ion 1501 is Not Based on Congr ess’ Power t o Regulat e
Commer ce

The Secr et ar y has ar gued t hat Congr ess may enact Sect ion 1501
under t he Commer ce Clause. Because Sect ion 1501 does not involve any
commer ce, her ar gument fails.
Since ACA was enact ed last year , t he quest ion of whet her Congr ess
has t he power t o enact Sect ion 1501 under t he Commer ce Clause has
ar isen in many cases. Sect ion 1501 was upheld in t he Libert y, Mead and
TMLC Act ions but was declar ed unconst it ut ional in t he Florida and
Virginia Act ions.
6

Given t he dispar it y of t he opinions and t he gr avit y of t he issue, t he
quest ion of Congr essional power t o enact Sect ion 1501 should be decided
by t his Cour t . Amici offer t he following analysis t o t he Cour t .

6
The cour t s in t he Florida and Virginia Act ions disagr eed on whet her
Sect ion 1501 is sever able fr om ACA. The Virginia Act ion held Sect ion
1501 is sever able. The Florida Act ion held it is not sever able.

10

1. The individual mandat e involves no commer ce
Congr ess lacks power t o enact Sect ion 1501 under t he Commer ce
Clause. The language and st r uct ur e of ar t icle I, sect ion 8 make t his clear .
Under clause 3, t he power is “t o r egulat e” and t he object of t hat power is
“commer ce”.

The Const it ut ion does not give Congr ess power t o r egulat e all
commer ce. Rat her , t he Const it ut ion r est r ict s Congr ess t o r egulat ing a set
of only t hr ee t ypes of commer ce: (1) “wit h” t he Indians; (2) “among” t he
sever al St at es; and (3) “wit h” for eign nat ions. All t hr ee member s of t his
set necessar ily involve at least a dyad or pair of par t ies. Wit hout t wo or
mor e par t ies, t he wor ds “wit h” and “among” ar e meaningless.
Ther efor e, in deciding t his mat t er , t he Cour t should under t ake a
t wo-st ep analysis. Fir st , it should det er mine if Congr ess at t empt ed t o
r egulat e “commer ce.” Only if t his quest ion is answer ed affir mat ively,
should t he Cour t under t ake st ep t wo, an analysis of t he “int er st at e
commer ce” sub-clause.
Wit h r egar d t o st ep one, t he key is t o under st and t hat “commer ce”
may be viewed as t he int er r elat ionship, t r affic, agr eement or t r ansact ion
bet ween par t ies. For example, we may see vendor s pair ed wit h vendees;
seller s pair ed wit h buyer s; lessor s pair ed wit h lessees; bor r ower s pair ed
11

wit h lender s; and debt or s pair ed wit h cr edit or s. Expr essed in
mat hemat ical t er ms, “commer ce” is Euclid’s line bet ween t wo point s or
Einst ein’s int er val bet ween t wo point s on an ideal r igid body, wher e t he
point s r epr esent t he t wo par t ies and t he line or int er val r epr esent s t he
commer cial t r ansact ion, agr eement , t r affic or int er r elat ionship. Euclid,
Element s of Geomet ry 6 (Gr eek Text of J .L. Heiber g (1883-1885))(R.
Fit zpat r ick, ed. & t r anslat or ) (“And t he ext r emit ies of a line ar e point s”);
Alber t Einst ein, The Meaning of Relat ivit y 4 (5
t h
ed. 1956)(post humously);
cf., Paul A. Samuelson, Economics 3 (10
t h
ed., 1976) (Similar t o t he
definit ion of commer ce, “economics” is defined as r equir ing at least a
dyadic r elat ionship. “Economics… is t he st udy of t hose act ivit ies which,
wit h or wit hout money, involve exchange t r ansact ions among people”)
(emphasis added).
7

The U.S. Supr eme Cour t has long under st ood and r eit er at ed t hat
“commer ce”, by definit ion, necessar ily involves t wo or mor e par t ies.

7
Pr ofessor Samuelson’s t r eat ise was t he most popular economics t ext book
of t he second half of t he t went iet h cent ur y. He was Economic Advisor t o
Pr esident Kennedy and r eceived t he second Nobel Pr ize in Economics in
1970. Appar ent ly, t he 111
t h
Congr ess, The Secr et ar y and amici who
suppor t her , ignor e Samuelson’s definit ion of “economics” in or der t o
est ablish “subst ant ial economic effect s.”
12

The commer ce power “is t he power t o r egulat e; t hat is, t o pr escr ibe
t he r ule by which commer ce is t o be gover ned …” The Gibbons
Cour t , however , acknowledged t hat limit at ions on t he commer ce
power ar e inher ent in t he ver y language of t he Commer ce Clause.
It is not int ended t o say t hat t hese wor ds compr ehend t hat
commer ce, which is complet ely int er nal, which is carried on
bet ween man and man in a St at e, or bet ween differ ent par t s of
t he same St at e, and which does not ext end t o or affect ot her
St at es….

Unit ed St at es v. Lopez, 514 U.S. 549, 553 (1995)(quot ing Gibbons v.
Ogden, 22 U.S. (9 Wheat .) 1, 194-95 (1824)(Mar shall, Ch. J .)(emphasis
added).
While “commer ce” may occur bet ween t wo people, bet ween t wo
ent it ies, or bet ween a per son and an ent it y, t her e is no “commer ce” when
a single per son or ent it y is involved. Since Sect ion 1501 is an individual
mandat e, it does not per t ain t o a t r ansact ion, agr eement , t r affic or
int er r elat ionship bet ween t wo par t ies. Rat her Sect ion 1501 at t empt s t o
r egulat e individuals wher e no count er par t y exist s. The individual
mandat e involves no “commer ce”. Wit hout “commer ce”, t her e is no need t o
examine t he int er st at e commer ce sub-clause.
13

2. Cour t s may not r ely on Sect ion 1501’s “findings” t o est ablish
Congr essional power under t he Commer ce Clause

Amici believe t he “subst ant ial effect s” t est leads t o false posit ive
r esult s and should not be t he sole basis t o est ablish Sect ion 1501’s
const it ut ionalit y under t he Commer ce Clause.
The Secr et ar y has point ed t o a lit any of Congr essional “findings” t o
ar gue t hat Congr ess pr oper ly enact ed Sect ion 1501 under t he Commer ce
Clause - on t he basis t hat t he lack of adequat e insur ance cover age has a
subst ant ial effect upon t he economy. Defendant ’s Mot ion for Summar y
J udgment , Virginia Act ion, Doc 91, at 4, 7, 8, 11-13, 15-16, 21, 26-27, 33
(point ing t o findings in §§ 1501(a) & 10106(a). Applying t his r at ionale, a
cour t could easily find t he ot her enumer at ed power s of Congr ess
super fluous. The power s t o declar e war , est ablish post offices, and
pr ovide exclusivit y for invent or s obviously have subst ant ial economic
effect s. Under The Secr et ar y’s t heor y, t hese clauses ar e unnecessar y.
While a cour t may r efer t o Congr essional findings t o suppor t it s
conclusion t hat Congr ess has power t o enact a pr ovision, a cour t must be
able t o examine Congr essional “findings” if judicial r eview is t o have any
14

meaning.
8
No defer ence is war r ant ed. In t his case, Congr ess pr esent ed
findings which wer e based on numer ous assumpt ions and ext r apolat ions,
some of which cont r adict each ot her . Compare Sect ions 1501(a)(2)(E) and
10106.
Whenever Congr ess pr esent s “findings”, t hose so-called “findings”
ar e not fact s at all, but r at her somet hing else - a conclusion based on a
vot e. Congr essional “findings” oft en involve numer ous ext r apolat ions
based on a plet hor a of assumpt ions. Mor e t han a cent ur y ago, Mar k
Twain humor ously expr essed t he danger s of ext r apolat ion as follows:
In t he space of one hundr ed and sevent y-six year s t he Lower
Mississippi has shor t ened it self t wo hundr ed and for t y-t wo miles.
That is an aver age of a t r ifle over one mile and a t hir d per year .
Ther efor e, any calm per son, who is not blind or idiot ic, can see t hat
in t he Old Oolit ic Silur ian Per iod, just a million year s ago next
November , t he Lower Mississippi River was upwar d of one million
t hr ee hundr ed t housand miles long, and st uck out over t he Gulf of
Mexico like a fishing-r od. And, by t he same t oken any per son can
see t hat seven hundr ed and for t y-t wo year s fr om now t he Lower
Mississippi will be only a mile and t hr ee-quar t er s long….

8
When a cour t blindly accept s Congr essional findings as fact s, it amount s
t o a der elict ion of it s dut ies. Long ago, t he U.S. Supr eme Cour t said: “[i]t
is emphat ically t he pr ovince and dut y of t he judicial depar t ment t o say
what t he law is.” Marbury v. Madison, 5 U.S. (1Cr .) 137, 177 (1803). It is
not fr ee t o “close [it s] eyes on t he Const it ut ion, and see only t he law, [e.g.
ACA].” Id. at 178.
15

Daniel Huff, How t o Lie wit h St at ist ics 142 (1954)(quot ing Mar k Twain,
Life on t he Mississippi).
Saying somet hing is a fact does not make it so. For example, under
Sect ion 1501(a)(2)(E), Congr ess made t he following finding: “Half of all
per sonal bankr upt cies ar e caused in par t by medical expenses….” In
Sect ion 10106 (which amended Sect ion 1501), Congr ess made t he
following cont r adict or y finding: “62 per cent of all per sonal bankr upt cies
ar e caused in par t by medical expenses.” It is impossible for bot h
“findings” t o be t r ue. Per haps, neit her is t r ue.
Consider ing t his int er nal cont r adict ion and t he inher ent danger s
associat ed wit h ext r apolat ing a decade int o t he fut ur e, Amici r espect fully
suggest t hat t he Cour t not defer t o t he Congr essional findings concer ning
Sect ion 1501 t o est ablish t he power of Congr ess t o enact t he individual
mandat e. Rat her , t he Cour t should quest ion t he validit y of t he under lying
assumpt ions and ext r apolat ions.
B. Congr ess May Not Violat e Const it ut ional Const r aint s

It is axiomat ic t hat a feder al law must comply wit h t he ent ir e
Const it ut ion as amended. ACA has not come close. As physicians, Amici
ar e concer ned by t he mandat ed invasion of pat ient pr ivacy r equir ed by
16

ACA. As cit izens, Amici ar e concer ned t hat Congr ess r epeat edly violat ed
t he Pr esent ment Clause by simult aneously enact ing and amending many
of ACA’s pr ovisions, including Sect ion 1501. Ther efor e, t he Cour t should
affir m t he unconst it ut ionalit y of Sect ion 1501.
1. Sect ion 1501 may not be enact ed and amended simult aneously
Congr ess has simult aneously enact ed Sect ions 1501 and 10106 of
ACA. The for mer pr ovision cr eat es 26 U.S.C. §5000A, 124 St at . at 244,
while t he lat t er pr ovision r evises some por t ions of 26 U.S.C. §5000A, 124
St at . at 909. These pr ovisions cont ain incompat ible definit ions of “penalt y
amount .”
Congr ess may not simult aneously enact and r evise any pr ovision
wit hin t he same st at ut e because t hat simult aneit y violat es t he
Pr esent ment Clause, t he “single, finely wr ought and exhaust ively
consider ed, pr ocedur e” which is used t o enact Feder al legislat ion.
Immigrat ion and Nat uralizat ion S ervice v. Chadha, 462 U.S. 919,
951(1983); Clint on, 524 U.S. at 439-440.
Alt hough simult aneously enact ing and r evising 26 U.S.C. §5000A
may have led t o needless complexit y, incongr uit y, and ambiguit y for our
cit izenr y and judiciar y, t he cr it ical const it ut ional pr oblem is t hat bot h t he
17

or iginal and r evised ver sions of Sect ion 5000A wer e pr esent ed t o t he
Pr esident at t he same t ime. Consequent ly, 26 U.S.C. §5000A did not exist
at t he t imes t he House and Senat e passed H.R. 3590 nor did it exist when
H.R. 3590 was pr esent ed t o t he Pr esident . Consequent ly, Sect ion 10106
mer ely at t empt s t o amend a nullit y. For 26 U.S.C. §5000A t o be
r evisable, Sect ion 10106 must be enact ed aft er sect ion 1501, not
simult aneously wit h it .
Under t he Pr esent ment Clause, t he Pr esident may only appr ove or
vet o a bill in it s ent ir et y. Because Sect ions 1501 and 10106 cont ained
incompat ible definit ions of “penalt y amount ,” it is impossible for t he
Pr esident t o have appr oved H.R. 3590 (which became ACA) in it s ent ir et y.
The Pr esident ’s appr oval of t he definit ion in 1501 cont r adict ed t he
definit ion pr esent ed t o him in 10106 and t he Pr esident ’s appr oval of t he
definit ion in 10106 cont r adict ed t he definit ion in 1501. The incompat ible
definit ions of “penalt y amount ” cont ained in Sect ions 1501 and 10106
pr event ed t he House and Senat e fr om having agr eed on t he definit ion of
“penalt y amount .” In ot her wor ds, t he House’s definit ion under 1501
negat ed t he Senat e’s definit ion under 10106 and t he House’s definit ion
under 10106 negat ed t he Senat e’s definit ion under 1501.
18

“[R]epeal of st at ut es, no less t han enact ment , must confor m t o Ar t .
I.” Clint on, 524 U.S. at 438. The same pr inciple applies t o r evisions and
amendment of st at ut es. Consequent ly, 26 U.S.C. §5000A should not have
been enact ed and r evised wit hin t he same st at ut e. This unconst it ut ional
pr act ice complet ely infect s ACA. Indeed, pur suant t o Tit le X, Congr ess
at t empt ed t o simult aneously enact and amend mor e t han ninet y ACA
pr ovisions.
9

Dur ing debat e over t he Const it ut ion’s r at ificat ion, J ames Madison
st at ed t hat laws should be under st andable, not t oo long, and “not be
r evised befor e t hey ar e pr omulgat ed.” THE FEDERALIST No. 62, at
381(Madison) (C. Rossit er , ed. 1961). He wr ot e:
The int er nal effect s of a mut able policy ar e st ill mor e calamit ous. It
poisons t he blessings of liber t y it self. It will be of lit t le avail t o t he
people t hat t he laws ar e made by men of t heir own choice if t he laws
be so voluminous t hat t hey cannot be r ead, or so incoher ent t hat
t hey cannot be under st ood; if t hey be r epealed or r evised befor e t hey
ar e pr omulgat ed, or under go such incessant changes t hat no man,
who knows what t he law is t oday, can guess what it will be
t omor r ow. Law is defined t o be a r ule of act ion; but how can t hat be
a r ule, which is lit t le known, and less fixed?

Id. (emphasis added). Congr ess ignor ed Madison’s pr escient war ning and
passed H.R. 3590, a 2400 page bill, which became ACA upon t he

9
124 St at . at 883-1024.
19

Pr esident ’s signat ur e. Wit hin days of passing ACA, Congr ess also passed
H.R. 4872 which became t he Reconciliat ion Act .
Given ACA’s lengt h and t he number of simult aneously enact ed and
amended pr ovisions, J ames Madison sur ely would have consider ed ACA
t oo long and t oo incoher ent t o be under st ood. Indeed, ACA’s lengt h and
complexit y have not gone unnot iced. See Or der , Florida Act ion, Doc 167
at 16 (“[ACA], as pr eviously not ed, is obviously ver y complicat ed and
expansive. It cont ains about 450 separ at e pr ovisions wit h differ ent t ime
schedules for implement at ion.”); see also Michael O. Leavit t , “Healt h
r efor m’s cent r al flaw: Too much power in one office,” Washingt on Post
(Febr uar y 18, 2011)(r efer r ing t o near ly 2000 power s given t o The
Secr et ar y by ACA); see also Er nst & Young, LLP, Summar y of t he Pat ient
Pr ot ect ion and Affor dable Car e Act , incor por at ing The Healt h Car e and
Educat ion Reconciliat ion Act (May 2010)(This summary is pr esent ed in a
small font and is 159 pages long).
20

2. Congr ess may not invade a pat ient ’s pr ivacy
The individual mandat e is an assault on t he confident ialit y of t he
physician- pat ient r elat ionship.
10
For mor e t han t wo millennia,
physicians and pat ient s have under st ood t hat a pat ient r eceives bet t er
car e if t he pat ient candidly discloses pr ivat e infor mat ion, e.g. medical
hist or y, sympt oms, and t r eat ment s, t o t he physician. U.S. Congr ess,
Office of Technology Assessment , Prot ect ing Privacy in Comput erized
Medical Informat ion, OTA-TCT-576 (pages 5-6, 26-30)(U.S. G.P.O., Sept .
1993). To mandat e t he pur chase of medical insur ance and t hen t o r equir e
disclosur e of t hat insur ance is t ant amount t o pr oviding t he gover nment ,
as well as ent it ies it out sour ces t o, wit h a r oadmap t o pat ient s’ medical
infor mat ion. Under t he Const it ut ion, a pat ient has a r ight t o a “pr ivat e
enclave” wher e his or her medical car e and infor mat ion ar e pr ivat e. The
individual mandat e oblit er at es t hat enclave.
In West inghouse, t he Thir d Cir cuit eloquent ly applied t he “pr ivat e
enclave” pr inciple t o a case involving confident ialit y of medical
infor mat ion:

10
This assault is compounded by Sect ion 1502’s compelled disclosur e of
cover age.
21

Ther e can be no quest ion t hat an employee’s medical r ecor ds, which
may cont ain int imat e fact s of a per sonal nat ur e, ar e well wit hin t he
ambit of mat er ials ent it led t o pr ivacy pr ot ect ion. Infor mat ion about
one’s body and st at e of healt h is mat t er which t he individual is
or dinar ily ent it led t o r et ain wit hin t he “pr ivat e enclave wher e he
may lead a pr ivat e life.”

Id. at 577 (quot ing Unit ed St at es v. Grunewald, 233 F.2d 556, 581-82 (2d
Cir . 1956)(Fr ank, J ., dissent ing), rev’d, 353 U.S. 391 (1957)). In
Grunewald, J udge Fr ank said:
That r ight is t he hallmar k of our democr acy. The t ot alit ar ian
r egimes scor nfully r eject t hat r ight . They r egar d pr ivacy as an
offense against t he st at e. Their goal is ut t er deper sonalizat ion.
They seek t o conver t all t hat is pr ivat e int o t he t ot ally public, t o
wipe out all unique “pr ivat e wor lds,” leaving a “public wor ld” only, a
la Or well’s t er r ifying book, “1984.” They boast of t he r esult ant
gr eat er efficiency in obt aining all t he evidence in cr iminal
pr osecut ions. We should know by now t hat t heir vaunt ed efficiency
t oo oft en yields, unjust , cr uel decisions, based upon unr eliable
evidence pr ocur ed at t he sacr ifice of pr ivacy. We should be awar e of
moving in t he dir ect ion of t ot alit ar ian met hods, as we will do if we
eviscer at e any of t he const it ut ional pr ivileges.

Grunewald, 223 F.2d at 582. Pr eviously, J udge Fr ank descr ibed t he r ight
t o a “pr ivat e enclave” in Unit ed St at es v. On Lee, 193 F.2d 306, 315-16 (2d
Cir . 1951) (Fr ank, J ., dissent ing), aff’d, 343 U.S.747 (1952):
“A man can st ill cont r ol a small par t of his envir onment , his house;
he can r et r eat t hence fr om out sider s, secur e in t he knowledge t hat
t hey cannot get at him wit hout disobeying t he Const it ut ion. That is
st ill a sizable hunk of liber t y – wor t h pr ot ect ing fr om encr oachment .
A sane, decent , civilized societ y must pr ovide some oasis, some
shelt er fr om public scr ut iny, some insulat ed enclosur e, some
22

enclave, some inviolat e place which is a man’s cast le.”

On Lee, 193 F.2d at 315-16.
11

The r ight t o a “pr ivat e enclave” under lies Four t h and Fift h
Amendment jur ispr udence. Miranda, 384 U.S. at 460; Murphy v.
Wat erfront Commission of New York Harbor, 378 U.S. 52, 55
(1964)(pr ivilege against self-incr iminat ion); Tehan v. Unit ed St at es ex rel.
Shot t , 382 U.S. 406, 415-16 (1966)(bot h t he Four t h and Fift h
Amendment s involve t he “r ight of t he individual t o be let alone”);
O’Connor v. Ort ega, 480 U.S. 709,717 (1987)(Four t h Amendment r ight s of
public employees).
In Miranda, t he Cour t showed a concer n r egar ding cr eeping
encr oachment s on individual liber t ies and also quot ed Grunewald at a
cr ucial point in it s analysis:
Those who fr amed t he Const it ut ion and t he Bill of Right s wer e
awar e of subt le encr oachment s on individual liber t y. They knew
t hat “illegit imat e and unconst it ut ional pr act ices get t heir fir st
foot ing … by silent appr oaches and slight deviat ions fr om legal
modes of pr ocedur e… The pr ivilege was elevat ed t o const it ut ional
st at us and has always been “as br oad as t he mischief against which
it seeks t o guar d…”
Thus we may view t he hist or ical development of t he pr ivilege

11
This passage was quot ed in Silverman v. Unit ed St at es, 365 U.S. 505,
511-12 n.4 (1961).
23

[against self-incr iminat ion] as one which gr oped for t he pr oper scope
of gover nment al power over t he cit izen. As a “noble pr inciple oft en
t r anscends it s or igins,” t he pr ivilege has come r ight fully t o be
r ecognized in par t as an individual’s subst ant ive r ight , a “r ight t o a
pr ivat e enclave wher e he may lead a pr ivat e life. That r ight is t he
hallmar k of our democr acy.” [Grunewald, 233 F.2d at 579, 581-582].
We have r ecent ly not ed t hat t he pr ivilege against self-incr iminat ion
– t he essent ial mainst ay of our adver sar y syst em – is founded on a
complex of values … All t hese policies point t o one over r iding
t hought : t he const it ut ional foundat ion under lying t he pr ivilege is
t he r espect a gover nment – st at e or feder al – must accor d t o t he
dignit y and int egr it y of it s cit izens.

Miranda, 384 U.S. at 459-60(emphasis added)(cit at ions omit t ed).
To pr ot ect per sonal medical infor mat ion, t he most pr ivat e of pr ivat e
enclaves, an individual must be allowed t o pay for medical car e dir ect ly
and not be r equir ed t o pur chase healt h insur ance. Typically, at t he
moment a healt h insur ance car r ier enr olls an individual, it r equir es t hat
individual t o disclose his or her complet e medical hist or y. See, e.g.,
Empir e BlueCr oss/BlueShield For m ENR-02968 (Rev1/11) at 5.
Fur t her mor e, as an insur ance car r ier pays claims t o physicians, hospit als,
phar macies, et c., on an individual’s healt h insur ance policy, t he car r ier
amasses mor e of t hat individual’s pr ivat e medical infor mat ion. By for cing
individuals t o pur chase medical insur ance, ACA dest r oys a pat ient ’s r ight
24

and abilit y t o keep medical infor mat ion pr ivat e.
12

To put a pat ient ’s const it ut ional r ight s in per spect ive, consider t he
vict im and per pet r at or of a violent cr ime. While Miranda allows a
per pet r at or t o r et r eat int o a “pr ivat e enclave,” ACA appear s t o pr event a
vict im-pat ient fr om t ot ally r emaining silent by compelling t he vict im-
pat ient t o disclose cer t ain pr ivat e infor mat ion. The vict im-pat ient ’s
pr ivat e enclave is t her eby compr omised. The vict im-pat ient is put in a
wor se posit ion t han his or her alleged at t acker .
II. ACA IS UNCONSTITUTIONAL BECAUSE SECTION 1501 IS
NOT SEVERABLE

The t r adit ional t est for sever abilit y is well-known:
“The st andar d for det er mining t he sever abilit y of an
unconst it ut ional pr ovision is well est ablished: Unless it is evident
t hat t he Legislat ur e would not have enact ed t hose pr ovisions which
ar e wit hin it s power , independent ly of t hat which is not , t he invalid
par t may be dr opped if what is left is fully oper at ive as a law.”
Alask a Airlines v. Brock , 480 U.S. 678, 684 (1987)(int er nal quot at ion
mar ks omit t ed). While t he Act it self cont ains no st at ement of
whet her it s pr ovisions ar e sever able, “[i]n t he absence of a

12
The r isk of loss of pr ivat e infor mat ion is r eal. Today, many pr ivat e
insur er s, feder al agencies and t heir r espect ive business associat es
out sour ce at least par t of t heir oper at ions. GAO, PRIVACY: Domest ic and
Offshor e Out sour cing of Per sonal Infor mat ion in Medicar e, Medicaid, and
TRICARE, Repor t No. 06-676 (Sept . 2006). Ther efor e, a pat ient has lit t le
act ual knowledge or cont r ol over who sees his or her confident ial
infor mat ion.
25

sever abilit y clause,… Congr ess’ silence is just t hat – silence – and
does not r aise a pr esumpt ion against sever abilit y.” Id. at 686….

New York v. U.S., 505 U.S. 144, 186 (1992). Nor , as a mat t er of logic and
judicial consist ency, should t hat Congr essional silence r aise a
pr esumpt ion in favor of sever abilit y.
The Secr et ar y is pr event ed fr om ar guing t hat Sect ion 1501 is
sever able if it is unconst it ut ional because she r epeat edly admit t ed t hat
t he individual mandat e is “essent ial” t o ACA. Defendant ’s Mot ion for
Summar y J udgment , Virginia Act ion Doc 91 at 1, 13-16, 25-29; Or der
Gr ant ing Summar y J udgment , Florida Act ion Doc 150 at 63-64 (“t he
defendant s concede t hat [t he individual mandat e] is absolut ely necessar y
for t he Act ’s insur ance mar ket r efor ms t o wor k as int ended. In fact , t hey
r efer t o it as an ‘essent ial’ par t of t he Act at least four t een t imes in t heir
mot ion t o dismiss”); Br ief for Appellant , Virginia Appeal, Doc 21 at 34-39;
Clarificat ion Order at 6-8.
Fur t her mor e, neit her Sect ion 1501 nor any ot her unconst it ut ional
pr ovision in ACA may be sever ed t o save t he r emainder of ACA because
sever ance is a judicial line it em vet o. In Clint on, Pr esident ial line it em
vet oes wer e declar ed unconst it ut ional. 524 U.S. at 447-449. In Chadha,
Congr essional vet oes wer e declar ed unconst it ut ional. 462 U.S. at 959.
26

Alt hough t he U.S. Supr eme Cour t has, on occasion, sever ed defect ive
pr ovisions of feder al st at ut es, see e.g., Alask a Airlines, 480 U.S.678, t hat
r emedy should be unavailable t o cour t s in light of Clint on and Chadha.
The Bicamer al and Pr esent ment Clauses r equir e t he House and Senat e t o
pass pr ecisely t he same t ext – not a single wor d or punct uat ion may var y
bet ween t he bills passed by each chamber . Clint on, 524 U.S. at 448. The
judiciar y, like t he Pr esident , has no power t o r ewr it e a st at ut e.
Fur t her mor e, t he idea t hat t he judiciar y be joined wit h t he execut ive in a
“council of r evision” was consider ed and expr essly r eject ed by t he Dr aft er s
of t he Const it ut ion. Br ief of Senat or s Rober t C. Byr d, Daniel Pat r ick
Moynihan, and Car l Levin as Amici Curiae in Suppor t of Appellees 9-10 in
Clint on v. Cit y of New York (Docket No. 97-1374).
In addit ion t o violat ing t he Const it ut ion’s let t er and spir it , t he
pr act ice of sever ing a defect ive pr ovision fr om a st at ut e lacking a
sever abilit y clause is bad policy because: (1) it facilit at es legislat ive
sloppiness – a bill’s aut hor knows t he const it ut ionalit y of it s pr ovisions
will be addr essed piecemeal; (2) it allows judicial act ivism - a cour t can
subst it ut e it s own judgment for t he legislat ive bar gain t hat was st r uck in
27

Congr ess and agr eed t o by t he Pr esident ;
13
and (3) it encour ages omnibus
legislat ion – which member s of Congr ess may not have sufficient t ime t o
r ead and under st and pr ior t o cast ing t heir vot es.
14

Regar dless of t he defer ence accor ded t o Congr ess, t his Cour t may
not sever a defect ive pr ovision fr om a st at ut e in t he absence of a
sever abilit y clause because sever ance is a judicial line it em vet o. This
pr act ice subst ant ially alt er s t he disper sion of power s incor por at ed int o t he
Const it ut ion. It is t ime t o r et ur n “all legislat ive power ” t o Congr ess as
r equir ed by t he Const it ut ion’s fir st clause. U.S. CONST. ar t . I, sec. 1, cl. 1.

13
Congr ess, like ot her legislat ur es, is an inst it ut ion t hat is conducive t o
vot e t r ading and log-r olling act ivit ies. To enact a law, a major it y coalit ion
must be for med. Consequent ly, member s of Congr ess oft en cooper at e t o
fur t her an individual or collect ive agenda. Passage of a bill might r equir e
t he vot e of a single member of Congr ess or Senat or . If ACA had cont ained
a sever abilit y clause, t he legislat ive bar gain made by member s of
Congr ess pr obably would not have been r eached. Indeed, a sever abilit y
clause was included in an ear ly ver sion of H.R. 3590, but was excluded
fr om ACA, as enact ed.
14
The Pr esent ment Clause dir ect s “r econsider at ion” of vet oed bills -
implicit ly r equir ing member s of Congr ess t o act ually “consider ” a bill.
28

CONCLUSION

For t he for egoing r easons, Amici believe t hat t his Cour t should
affir m t hat Sect ion 1501 is unconst it ut ional but r ever se wit h r espect t o it s
sever abilit y and find t hat Sect ion 1501 is not sever able fr om t he
r emainder of ACA.

Respect fully submit t ed,


s/ Andr ew L. Schlafly

ANDREW L. SCHLAFLY
939 Old Chest er Rd.
Far Hills, NJ 07931
(908) 719-8608
(908) 934-9207 (fax)

DAVID P. FELSHER
488 Madison Avenue
New Yor k, NY 10022
(212) 308-8505
(212) 308-8582 (fax)

At t or neys for Amici Curiae
Dat ed: Apr il 4, 2011
29


CERTIFICATE OF COMPLIANCE

This br ief has been pr epar ed using four t een point , pr opor t ionat ely
spaced, ser if t ypeface: Micr osoft Wor d

2007, Cent ur y Schoolbook, 14 point .
Excluding t he par t s of t he br ief exempt ed by Fed. R. App. P.
32(a)(7)B)(iii), t his br ief cont ains 5,475 wor ds.


s/ Andr ew L. Schlafly
At t or ney for t he Amici Curiae
30

CERTIFICATE OF SERVICE
This is t o cer t ify t hat on Apr il 4, 2011, I elect r onically filed t he
for egoing Br ief of Associat ion of Amer ican Physicians and Sur geons, Inc.,
J anis Chest er , M.D., Mar k J . Hauser , M.D., Guent er L. Spanknebel, M.D.
and Gr aham L. Spr uiell, M.D., as Amici Curiae in Suppor t of
Appellee/Cr oss-Appellant wit h t he Cler k of t he Cour t using t he CM/ECF
Syst em. I cer t ify t hat all par t ies in t his case ar e r egist er ed CM/ECF user s
and t hat ser vice will be accomplished by t he CM/ECF syst em.


s/ Andr ew L. Schlafly
At t or ney for Amici Curiae

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