Judge Allows Virginia Lawsuit Against Health Care Bill; Violates Commerce Clause

US District Court Judge Henry Hudson ruled today that a lawsuit filed in March by Virginia Attorney General Ken Cuccinelli can proceed. The case, Commonwealth of Virginia v. Sebelius 10-cv- 00188, asserts that the Patient Protection and Affordable Care Act violates the Constitution’s Commerce Clause by requiring individuals to buy insurance or face a tax.

Virginia Lawsuit and Health Insurance Mandate

The Commerce Clause (Article I, Section 8, Clause 3) states that the US Congress shall have the power “to regulate Commerce with foreign Nations, and among the several States, and with the Indian tribes.”
Under the new health care law, Americans will be required to purchase health insurance or face a penalty of 2.5% of their gross income. Judge Hudson is allowing the suit to continue because, he says, “No court has ever ruled on whether it’s constitutional to require Americans to purchase a product.”
Throughout its history, the Commerce Clause has been used primarily to regulate the interstate sale of tangible products. This would be the first time the law has been extended to services such as health insurance, which would obviously benefit from increased sales because of the federal requirement.
"While this case raises a host of complex constitutional issues, all seem to distill to the single question of whether or not Congress has the power to regulate -- and tax -- a citizen's decision not to participate in interstate commerce," Hudson wrote in his 32-page decision.
The Virginia General Assembly has passed its own legislation this year which exempts state residents from the federal coverage mandate.
The defendant, the Health and Human Services Department overseen by Secretary Kathleen Sebelius, argues that at some point everyone will need medical services and is therefore either a “current or future participation in the health care market”. This, she says, allows the government to tax such services.
Other states have also challenged the constitutionality of the new healthcare law, but Virginia’s is the first to go before a judge. According to the Washington Post, a full hearing is scheduled for October.

Not following doctor's orders: Prescription abandonment

Failure to have a prescription filled can undermine medical treatment, result in increased health care costs and potentially have devastating results for the patient. An editorial in the Nov. 16 issue of the Annals of Internal Medicine highlights the problem and issues a call to action. In the editorial, "Prescription Abandonment: Another Path to Medication Nonadherence," Michael D. Murray, PharmD, MPH, a Regenstrief Institute, Inc. investigator and Purdue University professor of pharmacy practice, and Jeff Harrison, Ph.D., of the University of Auckland, New Zealand, observe that precise information on the dimensions of the problem does not exist. How many prescriptions are not brought to a pharmacy? How many prescribed medications are never retrieved? Will the rising use by physicians of electronic prescribing alter these numbers?
Dr. Murray and Dr. Harrison call for further study of the scope of the problem and evaluation of potential solutions. They also urge investigation of the impact of relationships between abandonment of prescriptions and clinical outcomes.
"Although to date studies have not shown how big a problem it is, prescription abandonment is not new, and is certainly affected by whether patients can afford their medications or even the co-payment. With the increasing use of electronic prescriptions that go directly from the physician's office to the pharmacy, we also need to explore whether the further elimination of the patient from the transmittal process has an impact on the likelihood that the prescription won't be picked up," said Dr. Murray.
Studies have estimated that the number of prescriptions not taken to the pharmacy to be filled or not picked up range from 20 percent to less than 2 percent of all prescriptions written. The number of studies used to generate these numbers is not large and some of these studies have focused on medications for a specific disease and may not apply to all health care settings.
Dr. Murray and Dr. Harrison note that physicians are often unaware of patient's out-of pocket costs for drugs and call for better physician-pharmacist collaboration surrounding medication choice and expense.
"Prescription abandonment may be driven by cost. The complexity of drug reimbursement in the United States is a particular challenge for physicians, pharmacists and patients alike. Explicitly taking into account both cost and the patient's ability to pay when considering treatment options is important and it's an area where pharmacists can assist physicians," said Dr. Harrison, who is a 2010 Fulbright New Zealand Senior Scholar based at the Regenstrief Institute.
Although prescription abandonment is only one, and probably not the most important, way of not following doctor's orders, Dr. Murray and Dr. Harrison say its impact on patient health make it necessary to study. Based on their own research, they believe it is at least partially remediable.