- The Trump Administration urged an appeals court in Texas to throw out the entire Affordable Care Act, saying the individual mandate compelling people to purchase insurance can't be carved out from the rest of the law. This is a change, which the administration signaled in March, from its earlier position in the lower court that portions of the law apart from the individual mandate could be saved.
- The lawsuit, now a political football of sorts, likely will make its way to the U.S. Supreme Court. Democrats immediately blasted the administration's argument, with Senate Minority Leader Chuck Schumer, D-N.Y., calling it "heartless and wrong" because it would "gut protections for people with pre-existing conditions and strip away health care from millions." House Speaker Nancy Pelosi called the move a "monstrous campaign to destroy pre-existing condition protections and Americans' access to affordable health care."
- If the administration succeeds in convincing the Fifth Circuit to toss the ACA entirely, health insurers, hospitals and patients will feel the effects as some 20 million people are expected to lose their coverage and certain required coverages will end.
The administration argues for the first time in its appeal brief that none of the law can be saved. The brief states the ACA's individual mandate, now toothless because it lacks any financial penalty, can't be separated from the rest of the act. It also argued the mandate is inseverable from community rating and guaranteed issue provisions of the law.
Although the administration argued trial judge Reed O'Connor of the U.S. District Court for the Northern District of Texas correctly ruled the entire law invalid, it also argued the plaintiffs are only entitled to get legal relief from the provisions that directly harm them.
University of Michigan law professor Nicholas Bagley called that argument the most curious part of the brief.
3. But by far the strangest thing in the brief is the argument that (1) Judge O'Connor was right to declare the whole ACA invalid but (2) that plaintiffs lack standing to get relief except with respect to provisions that directly cause them harm. pic.twitter.com/GAudpM2zg7— Nicholas Bagley (@nicholas_bagley) May 1, 2019
If the law is ultimately overturned as unconstitutional, the repercussions would reverberate throughout the entire U.S. health care economy, upending healthcare markets, affecting insurers, hospitals and consumers.
The American Hospital Association and the American Medical Association have been outspoken about the potential disruption that could ensue.
In addition to the millions losing coverage, provisions requiring benefits for women's health, behavioral health and prescription drugs would end.
The ACA touches nearly every aspect of healthcare in America, from its mandate that insurers cover pre-existing conditions to changes in how hospitals and doctors are paid to the massive expansion of the Medicaid program. And it's been popular with voters and credited with slashing the rate on uninsured in the U.S.
The appeal's brief filing comes after a December 2018 ruling O'Connor of the Federal District Court for the Northern District of Texas, in which he found the ACA unconstitutional. States opposing overturning the ACA appealed to the Fifth Circuit.