A fifth U.S. District Court has issued a decision on a challenge to the constitutionality of the Patient Protection and Affordable Care Act (ACA) in Mead et al. v. Holder et al., finding the law is constitutional. Although legal challenges to the ACA have not been limited to the individual requirement to maintain health insurance coverage, the vast majority of cases have focused on this provision, commonly referred to as the individual mandate. To date, three district courts have held that Congress has the authority to require purchase of health insurance coverage as a reasonable exercise of its Commerce Clause powers, and two have struck down the provision as unconstitutional. A Florida district court has gone one step further, holding that the individual mandate, as an essential part of the ACA, was non-severable from the remainder of the Act and, as a result, struck down the entire statute.

This is an updated version of a brief originally published on November 15, 2010. Shortly after President Obama signed the Patient Protection and Affordable Care Act (ACA)^[1] into law, opponents of the law filed a series of legal challenges in federal court. This health reform implementation brief provides an overview of the legal challenges by identifying and providing summaries of the two major cases filed by states and select claims, not raised by the states, from other cases.