Rather overshadowed by the Supreme Court hearings on the constitutionality of the Patient Protection and Affordable Care Act (PPACA), another case involving a claim for health care ‘freedom’ has recently been dismissed by the DC circuit court of appeals. The case is entirely without any legal interest (or indeed legal merit) and, from a purely legal point of view, is barely worth reporting. Nonetheless from a broader political science perspective, it may be worth noting. From this perspective the ongoing health care litigation (of which Hall v Sebelius is a rather peripheral part) might tend to re-establish a view of the United States as ‘a nation of courts and parties’. It again emphasizes the role of institutions in US social policy and the importance of veto-points – in particular the courts - in the US system of governance. But, as Steinmo and Watts have highlighted, institutional barriers are not somehow accident or neutral in their distributional effect. Rather, as they emphasize, the ‘fragmented and federated national political system’ in the United States ‘yields enormous power to intransigent interest groups’, which in turn makes large-scale policy changes such as health reform difficult, if not impossible.