The individual mandate provision of the Patient Protection and Affordable Care Act has again been declared unconstitutional, this time by the U.S. Court of Appeals for the 11th Circuit in Atlanta, Georgia.
This is the first time a Democratic-appointed judge has voted against the mandate.
Ultimately, the decision on any requirement that every American must purchase health coverage will be decided by the U.S. Supreme Court.
The 11th Circuit decision is the second time a federal appellate court has ruled, but the first time one has stricken it down. In June, Court of Appeals for the Sixth Circuit in Cincinnati upheld the mandate.
The Atlanta court's 304-page opinion sided with a Florida federal district court, which said an individual mandate is not authorized under laws allowing the federal government to regulate interstate commerce.
While Friday's decision is a blow to the Obama administration, the Atlanta court said in a 2-1 vote that the rest of the healthcare reform law could stand.
Challenges against the act have been filed in various courts in 26 states.
Robert Zirkelbach, spokesman for the America's Health Insurance Plans gave this response:
"Throughout the health care reform debate there was broad agreement that enacting guarantee issue and community rating would cause significant disruption and skyrocketing costs unless all Americans have coverage.
"States that have implemented these laws without covering everyone have seen a rise in insurance premiums, a reduction of individual insurance enrollment and no significant decrease in the number of uninsured."
According to a report by Milliman, Inc., guarantee issue requires insurers to sell an individual health insurance policy without regard to a person's health.
Community rating requires that all consumers pay the same or similar premiums without regard to age, gender or health status. According to the report, these initiatives have the potential to cause individuals to wait until they have health problems to buy insurance.
That scenario could cause premiums to increase for all policyholders, increasing the likelihood that lower-risk individuals leave the market, which could lead to further rate increases. If this continues, the pool or market could essentially collapse or shrink to include only the high-risk population, Milliman said.
"Today's ruling by the 11th Circuit Court that the health insurance mandate is unconstitutional is a significant victory towards striking down a major component of the massively flawed healthcare legislation enacted last year," said Robert Alt, senior legal fellow and deputy director of the Center for Legal and Judicial Studies of the Heritage Foundation.
"This 2-1 decision was non-partisan; it is especially significant that Judge Hull, a Clinton appointee, co-authored the opinion. While it is disappointing that the court did not strike down the whole statute, that is a question that is ultimately best answered by the Supreme Court and there is every indication that that is where this case is headed next term," he said.