TAILIEUCHUNG - IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT - AUG 12, 2011

PHI has often financed the delivery of larger treatment volumes by offering higher payments to providers. Financial incentives linked to payment mechanisms exert a direct impact upon doctors’ This has contributed to a growth in the volumes of private hospital treatments in several countries where doctors have both public and private sector engagements, as in Australia and Ireland (Colombo and Tapay, 2003 and 2004b). Policy makers in many OECD countries allow differential doctors’ payments33 between public and private practice and permit dual appointments in order to keep the workforce motivated. Similarly, some countries – including Australia and Ireland – allow public hospitals to treat privately financed. | PUBLISH IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT FILED . COURT OF APPEALS ELEVENTH CIRCUIT Nos. 11-11021 11-11067 AU 12 2011 JOHN LEY ---------------------- CLERK . Docket No. 3 10-cv-00091-RV-EMT STATE OF FLORIDA by and through Attorney General STATE OF SOUTH CAROLINA by and through Attorney General STATE OF NEBRASKA by and through Attorney General STATE OF TEXAS by and through Attorney General STATE OF UTAH by and through Attorney General et. al. Plaintiffs - Appellees - Cross-Appellants versus UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES SECRETARY OF THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES UNITED STATES DEPARTMENT OF THE TREASURY SECRETARY OF THE UNITED STATES DEPARTMENT OF TREASURY UNITED STATES DEPARTMENT OF LABOR SECRETARY OF THE UNITED STATES DEPARTMENT OF LABOR Defendants - Appellants - Cross-Appellees. Appeals from the United States District Court for the Northern District of Florida August 12 2011 Before DUBINA Chief Judge and HULL and MARCUS Circuit Judges. DUBINA Chief Judge and HULL Circuit Judge 1 Soon after Congress passed the Patient Protection and Affordable Care Act Pub. L. No. 111-148 124 Stat. 119 2010 amended by Health Care and Education Reconciliation Act of 2010 HCERA Pub. L. No. 111-152 124 Stat. 1029 2010 the Act the plaintiffs brought this action challenging the Act s constitutionality. The plaintiffs are 26 states private individuals Mary Brown and Kaj Ahlburg and the National Federation of Independent Business NFIB collectively the plaintiffs .2 The defendants are the federal Health and Human Services HHS Treasury and Labor Departments and their Secretaries collectively the government . The district court granted summary judgment 1 to the government on the state plaintiffs claim that the Act s expansion of Medicaid is unconstitutional and 2 to the plaintiffs on their claim that the Act s individual mandate that 1This opinion was written jointly by Judges Dubina

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