While still having to deal with the current attempt to derail the Affordable Care Act (round two of the battles over the contraceptive mandate in the Supreme Court), the next challenge is working through the lower courts.  On Thursday, a Bush appointee to the U.S. District Court for the District of Columbia found that one part of the Affordable Care Act required annual appropriations.  In particular, the part involved requires insurer’s to reduce deductibles and co-payments for certain low-income persons.  In return, the federal government reimburses the insurer’s for those reductions.  While the insurer’s have a right to those payments, the District Court found that this entitlement still requires Congress to appropriate the money.  In the absence of an appropriation, an insurer only obtains payment upon filing a lawsuit (adding additional costs to the process).

The next step in this case will be an appeal to the D.C. Circuit.  At that stage, besides challenging the merits of this ruling, there will almost certainly be a claim that members of the House lack standing to pursue this challenge.  However, the one thing that this case makes clear is that — as long as Republicans have hopes of having the courts gut the Affordable Care Act — they will continue to file challenges to every section of the act.  Of course, given the current balance on the Supreme Court, voters can put this version of shopping for judicial activism to rest by electing a Democratic President and a Democratic Senate.  Maybe then, we will be able to turn our focus to making the health care system work better rather than fighting in court over the last reform.