Millions of people panicked on Friday, Dec 14, when a conservative Texas federal judge declared the Affordable Care Act unconstitutional. First, do not panic! There will be no enforcement of his decision while this decision wends its way through the appeals process. Even the Trump administration, no friend of the ACA, indicated that enrollment would continue for 2019 health plan coverage.
The original attempts to litigate the ACA out of existence were based on the individual mandate, the requirement that everyone had to purchase health insurance or face a fine. This requirement was the only way affordable health insurance policies could be offered. If young healthy people opted to not buy insurance and only older sicker people did, the cost of health insurance would be exorbitant. The original legal challenges were based on the supposed inability of Congress to force people to purchase insurance. The Supreme Court ruled that this was a form of taxation, and that since Congress did have the power to tax, the ACA was constitutional.
Last year the Republican-controlled Congress eliminated the monetary penalty on people who chose to not buy health insurance. The Texas judge ruled that since the individual mandate was key to making the ACA work, the entire law was now invalid. Note that Judge O’Connor did not immediately block enforcement of the ACA, presumably knowing that his decision would be appealed, as it will be. If his decision were to stand, all provisions of the Act would be invalid, including the highly popular features such as allowing children to stay on their family policies until age 26 and the elimination of insurance companies’ ability to exclude “pre-existing conditions” from coverage.
Democratic attorneys general from several states have been defending the ACA since the Trump administration refused to do so, and they will be appealing Judge O’Connor’s decision to the New Orleans-based Fifth U.S. Circuit Court of Appeals. Whatever the Appeals Court rules, you can be sure that the U.S. Supreme Court is the next step.
As I have noted in prior posts, exclusion of coverage for pre-existing conditions is a serious problem for half of all Americans, and there is a growing swell of public opinion that this pernicious practice must not be allowed. Hopefully common sense (and fear of not being re-elected) will allow members of Congress to do the right thing.
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