Washington State

Office of the Attorney General

Attorney General

Bob Ferguson

Multi-State Health Care Lawsuit


In December 2009, Attorney General Rob McKenna joined several state attorneys general in expressing concerns over provisions in the Senate health care bill that appeared to violate our federal Constitution. At that point, the states were primarily concerned about the special arrangement in the Senate’s health care proposal which permanently exempted Nebraska from paying its share of the additional Medicaid costs mandated by the bill. However, the states also indicated they had other legal or constitutional concerns with certain provisions of the proposed legislation.


On Tuesday, March 23, 2010, after further legal analysis and deliberation—and after notifying Governor Gregoire of his decision on March 22—McKenna joined fellow AGs in a  multi-state lawsuit challenging those specific provisions as an expansion of federal authority beyond that the states believe is allowed under the U.S. Constitution. Florida AG Bill McCollum filed this suit in U.S. District Court for the Northern District of Florida.

The two main provisions of the lawsuit deal with:
1) The unprecedented and unconstitutional requirement that individuals lacking insurance must purchase government-approved private insurance or face a fine; and
2) The massive expansion of the Medicaid program which will unconstitutionally require states to spend billions more on this program at a time when state budgets are already in crisis.

A total of  26 states have joined the suit including: Florida, Alabama, Alaska, Arizona, Colorado, Georgia Idaho, Indiana, Louisiana, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota,  Texas, Utah Iowa, Kansas, Maine, Wisconsin, Wyoming and Washington.   The National Federation of Independent Business and several individuals joined the suit in May 2010. Virginia has filed its own suit and Oklahoma has indicated it will do the same.

On Dec. 16, 2010, Judge Roger Vinson of the U.S. District Court for the Northern District of Florida heard arguments on the merits of multistate case. On Jan. 31, he sided with the 26 states, finding that Congress exceeded its Constitutional authority in approving a new health care mandate requiring all U.S. citizens to have or purchase government-approved health insurance or face a fine. Vinson also ruled that if the individual mandate is unconstitutional, the entire act must be nullified.

On August 12, 2011, the 11th Circuit issued a 2-1 opinion, ruling the federal government may not force individuals to purchase government-approved health insurance in the private marketplace.

The ruling upholds in part a decision by Florida Judge Roger Vinson earlier this year declaring the provision of the federal Affordable Care Act, requiring all Americans to have or purchase a government-approved health insurance policy in the private marketplace, unconstitutional.

In the 304-page decision, the majority differed with Vinson on the issue of whether the entire act should be nullified, ruling instead that the so-called “individual mandate” could be struck down without declaring the entire act unconstitutional.

The US Supreme Court heard an extraordinary three days of oral argument on this case on March 26, 27 and 28.

On June 28, 2012, the US Supreme Court upheld most of the Affordable Care Act--including the requirement that people who do not have health insurance coverage pay a tax if they do not obtain insurance approved by the federal government.  While the majority of the Court agreed with the states that the mandate violated the Commerce clause, the Court ultimately ruled that the mandate is constitutional under Congress’s taxing power.

The Court struck down the provision allowing the federal government to withhold from states existing Medicaid funds if states choose not to expand Medicaid as envisioned under the law, saying "Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding."