In a brief 78 page Opinion, Federal District Court Judge Roger Vinson of the U.S. District Court of the Northern District of Florida struck down portions of the the Patient Protection and Affordable Care Act on constitutional grounds.  The impact of that decision on PPACA initiatives in Florida, such as Accountable Care Organizations, remains to be seen, althought the DOJ has expressed its intent to appeal the ruling. In addition, Deputy Senior Advisor Stephanie Cutter responded:

We don't believe this kind of judicial activism will be upheld and we are confident that the Affordable Care Act will ultimately be declared constitutional by the courts.

She characterized the ruling as "well out of the mainstream of judicial opinion," noting that 12 federal judges have dismissed challenges to the law's constitutionality and two--in Michigan and Virginia--have upheld the law.