After a federal judge in Texas ruled Friday night that the Affordable Care Act (ACA) is unconstitutional, proponents of the ACA are already vowing to appeal the ruling.
The case was spearheaded by Attorney General Ken Paxton, who released a statement following Friday's decision by Federal District Court Judge Reed O'Connor of Texas.
"Today's ruling halts an unconstitutional exertion of federal power over the American healthcare system," Paxton said. "Our lawsuit seeks to effectively repeal Obamacare, which will give President Trump and Congress the opportunity to replace the failed social experiment with a plan that ensures Texans and all Americans will again have greater choice about what health coverage they need and who will be their doctor."
To get a better understanding of what the ruling means for the ACA, who would be impacted and what comes next, Houston Matters spoke with Dr. Vivian Ho, the director of the Center for Health and Biosciences at Rice University's Baker Institute for Public Policy.
What exactly was the ruling?
Last year Congress eliminated the ACA's individual mandate, which was a tax penalty that individuals would have to pay if they didn't have insurance.
"The judge decided that because Congress had eliminated the tax that individuals would have to pay if they did not have health insurance that the law is therefore no longer valid," Ho told Houston Matters. "There had been proponents that said that the individual mandate was one of three legs on a three-legged stool that was essential for the Affordable Care Act, and therefore because it was no longer there you could invalidate the entire Affordable Care Act."
It dates back to a 2012 Supreme Court case ruling where the court determined that it was a legitimate tax. "And [the court] said that it was essential to the Affordable Care Act, and so therefore the judge is saying well since it was essential and it was eliminated than the entire law no longer stands," Ho said.
What do proponents of the ACA say?
Some legal experts who disagree with the judge's ruling say that it's important to take into account Congress' intent when the legislators voted to eliminate the individual mandate.
"The legislators did not want to repeal the entire Affordable Care Act — they had a vote on that last year and decided not to repeal all of it,” Ho said. "Also I find it remarkable that the judge decided it was essential because that individual mandate was removed and we still have millions of people who signed up for health care insurance in 2019. Clearly it is not something that’s absolutely essential to the entire law."
Ezekiel Emanuel, who was one of the architects of the ACA, called the ruling "silly" in an interview with Morning Edition. "The mandate had no teeth because there was no tax penalty, and so it turns out it’s not essential to the law," he said. "And if it’s not essential to the law you can’t invalidate the whole Affordable Care Act, just because the mandate might not be operative anymore."
What happens now?
For the time being, nothing has changed on a day-to-day basis. "As of now the court did not discontinue the marketplace and the federal government is still keeping it in operation," Ho said. "Everybody who bought insurance, they’re ok. And they’re likely to remain ok. I think there’s a high probability that that decision will be overturned and the marketplace will continue as it has been going."
What would the implications be?
If the judge's decision is upheld in the future, there would be far-reaching impacts on the country's health care system. "People forget that the entire law is much bigger than just the marketplace. It effects everything in health care today," Ho said. "We would have total chaos actually."
Medicare is among the elements that would be impacted. "If you were to invalidate that law the Center for Medicaid and Medicare services would have a hard time figuring out how they’re supposed to be changing their reimbursements for physicians and hospitals," Ho said.
Among the other aspects that would be impacted are coverage of birth control and a requirement that health care providers disclose their financial relationships with each other.
Before anything would change on a daily basis, the case would need to go to an appeals court and then potentially to the Supreme Court if the decision is upheld, all of which would take several years. "The Supreme Court would likely hear the case in October 2019 and a decision would not be handed down until 2020," Ho said.
Listen to the full interview with Ho in the audio above.