Please note this post was updated 1/5/2011

In the midst of all of the legal challenges to the Affordable Care Act (ACA), there may be a lack of clarity for the average person regarding how these lawsuits proceed. We thought that we would take a brief moment to offer our readers a quick legal 101 on judicial process. Open our flowchart and follow along.

Where are we? The day President Obama signed the ACA into law, Attorney General Bill McCollum of Florida held his own press conference in an attempt to steal thunder and oppose what he termed an infringement upon “state sovereignty.” The domino effect was almost instantaneous as numerous conservative-leaning states and their AGs jumped aboard the McCollum bandwagon with cries of constitutional betrayal. In other states where AGs refused to sign on (Democrats), governors sought state legislative approval to one-up the AG and join anyway. This was successful in a handful of states. While other lawsuits emerged (Virginia, Michigan, New Jersey, California, etc.), the group led by McCollum currently holds the spotlight – mostly due to its expansive plaintiff list. The AG in Virginia, Kenneth Cuccinelli, has also successfully brought suit against the ACA but his lone ranger approach, according to legal scholars, leaves his case an unlikely candidate for the Supreme Court of the United States (SCOTUS). Currently, we have a handful of rulings both for the plaintiff (Virginia and most likely Florida) and the defendants (Lynchberg and Michigan). The cases in the most advanced stage of the judicial process are 1) Michigan – now in appeal (6th circuit) and 2) the Cuccinelli case – now entering the appeals phase (4th circuit). The Florida case is now awaiting judgment by U.S. District Judge Roger Vinson.

Where are we going? Structure The country is divided into 94 federal judicial districts. Districts do not cross state lines. Districts fall into 12 circuits across the country – in other words, each circuit is made up of a handful of states, containing districts. Where you file (the district) determines what circuit court you travel through if there is an appeal. While trials begin at the U.S. District court level, appeals to these decisions are heard at the circuit level. For example, there are two cases regarding the ACA in the state of Virginia. One district ruling favored the federal government (Lynchberg) and one district ruling favored the state of Virginia (Cuccenelli). Both losing parties will petition the 4th Circuit of Appeals to hear their cases, challenging the lower court decision. The final court of appeals is the U.S. Supreme Court.

Currently the appeals process is the focus of the challenges to ACA, however, it is worth a quick recap of how the cases got to this point.

Process Phase I – U.S. District Court: The opponents to ACA (plaintiffs) begin their legal challenge by presenting a brief to their U.S. District judge outlining their argument. In the case of the ACA, this is focused on the individual mandate (the requirement that all citizens have health insurance). There are additional arguments challenging the constitutionality of the ACA, but the mandate is the main issue. Once the judge hears from the involved parties (plaintiff and the defendant), he or she determines whether or not there is an issue that needs resolution. This is labeled the “pre-trial phase.”

Once this is determined, briefs for trial are submitted – these often include amicus briefs. The amicus brief, or a “friend of the court” document has received a great deal of attention because it is the only public avenue for comment. An outside party may seek permission from the judge to submit an amicus brief to include additional information on behalf of the plaintiff or the defendant. In the current cases, there are numerous amicus briefs filed on behalf of the opponents to ACA (plaintiffs) and the Federal government (defendant). Following the filing of this information and enough time for the judge to review it, a trial begins. The trial phase gives plaintiffs and defendants an opportunity to argue their case before the judge. Once this concludes, the judge will deliberate and issue a judgment. This process may take anywhere from four months to a year.

Phase II – U.S. Court of Appeals: One party will not like this judgment and will appeal – in other words, the losing party will ask another group of judges to review the U.S. District Court decision. In the appeals phase, a panel of judges (usually three) is appointed to hear a case within a circuit. The process mirrors the district process in that the plaintiff, the defendant, and friends of the court submit briefs before each party argues their case. The deliberation process differs in that three judges determine the outcome by majority vote. Once a ruling is handed down from the appeals panel – again, a party will not like the outcome — the losing party will most likely petition the Supreme Court to have their case heard (this is called “writ certiorari”). This process of brief submission, trial, deliberation and judgment can take up a year.

Phase III – U.S. Supreme Court (SCOTUS): The Supreme Court does not have to hear the case – it receives over 8,000 petitions to be heard annually and chooses to hear only a small percentage of these cases. However, given the fanfare around ACA, it is likely that the case will be heard and that there will be divided opinions from different circuits that demand clarification on the constitutional issues raised by ACA. When and if a case is heard by SCOTUS, it will fall into their annual calendar, beginning in October. Rulings are not issued, often, until the end of the term – which is in June. Therefore, if SCOTUS picks up a case (probably Florida) in 2012 or 2013, it may not be reconciled until June of 2013 or 2014. So, sit back and bide your time, this will take awhile.

Is this political? Of course it is! The strategy for Republicans is twofold: pick up court rulings in their favor in historically conservative circuits (ensuring success), therefore, branding ACA as dead in its tracks before full implementation and second, heading into SCOTUS with a constituent uproar over individual liberty supported by a handful or rulings and public discontent surrounding the individual mandate.

For supporters of the ACA, the best strategy is to gain public favor for the law. By engaging consumers and educating them about the positive effects and benefits of the ACA, advocates are increasing overall public support. If the law is embraced, it is less likely (and historically proven) that SCOTUS will tinker with a widely accepted law that benefits all of American society.

— Eva Marie Stahl, Policy Analyst