A panel of the 11th Circuit Court of Appeals struck down one provision of the law. The Administration can now ask the entire 11th Circuit to review the decision, or take it forward to the Supreme Court. The 9th Circuit has already determined that the entire law is constitutional, so the divided record pretty much requires that the Supreme gets it next.

The Constitutional theory is that this is within the purview of Congress under the 'regulation of interstate commerce' clause of the Constitution. Medical care is certainly big business, and little if any of it is strictly local.