TALLAHASSEE — As Florida Attorney General Bill McCollum argues against the new federal health care law today, he adds to a court file already swollen with "friend of the court" briefs from around the country.
The suit brought by McCollum and officials from 19 other states has become the nexus of a national debate over the new law, with more than 50 groups representing numerous organizations and thousands of individuals making legal arguments from the sidelines.
They include everyone from the American Nurses Association, the American Hospital Association and a group of economic scholars who oppose McCollum, to the American Center for Law and Justice and the Family Research Council, which want to see the entire law struck down.
Overwhelmingly, though, the briefs weigh on the side of the federal plan, with dozens of groups arguing on its behalf.
"The Affordable Care Act is an enormous step in the right direction," said Ron Pollack, executive director of the Washington, D.C.-based Families USA. "It will expand coverage for tens of millions of people who don't have it today."
For Pollack, the Florida lawsuit is significant because it addresses the issue of Medicaid.
McCollum argues that the law is unconstitutional not only because it forces people to buy health insurance or pay a fine, but because it infringes on states' powers by burdening them with an expanded Medicaid program.
Pollack, who heads a group founded more than 30 years ago to advocate for affordable health care, believes that expansion is highly necessary.
He said that in Florida, a family of three earning more than $9,704 a year doesn't qualify for Medicaid. If the federal law sticks, that annual income figure will rise to $24,352. It also gives single people and childless couples access to Medicaid.
Pollack's group submitted its brief along with the American Academy of Pediatrics and more than 20 other organizations.
In its paperwork defending the federal law, the Young Invincibles sets out to explain "the desperate situation young adults faced before the Affordable Care Act (ACA) passed."
The Young Invincibles was created in 2009 by Georgetown University law school students to support health care reform on behalf of people between 18 and 34 years old.
"There are 21 million uninsured young adults in the country. It's a predominantly low-income group that's struggling in the economy right now," said Aaron Smith, co-founder and executive director of the organization. "They just don't have access to the affordable comprehensive health insurance they need." The federal legislation, he said, helps them by making them eligible for Medicaid.
"For us the health care battle is personal," he said. "It's not something we think should be political. We can all agree there should be common ground around the fact that there are these problems in the system and real people are benefitting from reform."
He pointed to the predicament of Nia Heard-Garris, a 25-year-old medical student at Howard University who was dropped from her mother's insurance after getting married. With only minimal coverage offered to her and her husband through school, she avoided seeing a doctor for months about an ankle injury. After a series of office visits, X-rays and other tests, she faced a $7,000 medical bill that she negotiated down to $2,000.
Once the federal health care legislation passed, Heard-Garris was able to return to her mother's insurance.
"Being covered under my mother's insurance, I'll be more likely to get things taken care of earlier, and it won't be as big of a strain on the taxpayers," she said. "If you can't pay, you wait and wait and wait and it gets to the point where it's even more expensive."
Other briefs cover other issues.
Paperwork submitted by the American Association of People With Disabilities, the March of Dimes Foundation, the National Breast Cancer Coalition and others argues that the only way to guarantee that insurers don't reject people with pre-existing conditions is to require people who can afford insurance to have it. That offsets the increased cost to insurers.
In its brief, the American Hospital Association points out that hospitals treat tens of millions of uninsured people in their emergency rooms each year without pay. That, the AHA argues, drives up health care costs as hospitals seek to cover unpaid expenses.
Paolo Annino, a law professor at Florida State University who represents the Young Invincibles, noted that it's unusual for so many friend-of-the-court briefs to be filed in a trial court case.
"It's amazing when you look at who these folks are," he said.
He speculated that's occurred in part because the issue involves not just the law but factual questions about commerce.
"It's a question of how people buy insurance. Why people buy insurance. Why people have insurance. Why people don't have insurance. How obtaining insurance impacts the other people in the community. How people get their health care," he said. "A lot of folks are providing data to the court."
And, it's political.
"When you look at a lot of those briefs, what you have is partisan briefs," he said.
Dozens of state legislators from across the country filed a joint brief opposing McCollum, while incoming U.S. House Speaker John Boehner, a Republican from Ohio, and 24 U.S. senators — including Florida Sen. George LeMieux — filed briefs supporting him.
"The goal is universal coverage, and the individual mandate seeks to achieve this goal by requiring virtually all Americans to obtain and maintain a congressionally-approved level of health insurance," Boehner's statement reads.
State lawmakers serving in legislatures from Alabama to Wyoming see it differently.
"Health care reform was imperative for Americans, as well as for their state and local governments," they assert. "The ever-rising costs of and limited access to insurance coverage and health care have severely stressed the budgets of state government and American families, and literally result in tens of thousands of deaths each year."
Ken Klukowski, attorney for the Family Research Council, said the large number of briefs filed in this case is because it involves 20 states.
"There is no case that is more important than this one," he said. "If you were only going to pick one lawsuit to be involved with, this would be the one."
The Family Research Council, whose stated mission is to promote Judeo-Christian values, filed a brief opposing the federal law. In it, Klukowski argues that if the judge determines the provision requiring individuals to purchase health insurance is unconstitutional, the entire act should be rejected.
McCollum and attorneys for the federal government are set to begin oral arguments at 9 a.m. today in the federal courthouse in Pensacola.
Janet Zink can be reached at email@example.com or (850) 224-7263.