The long awaited legal ruling on the Affordable Care Act sustains a state of affairs the law has long endured — uncertainty.
Without a decisive ruling to uphold (or strike down) the law, that cloud will persist as the case winds its way through the courts, potentially back to the district court and eventually up to the U.S. Supreme Court.
The "decision is unfortunate because it leaves this critical law that so many Americans depend on in limbo. Without question, this decision stretches out the timeline on the final fate of pre-existing conditions and other important protections in the ACA," Chip Kahn, CEO of the Federation of American Hospitals, said in a statement.
The Fifth Circuit Court of Appeals late on Wednesday ruled the individual mandate — without the financial penalty — is now unconstitutional, but sent a key question about whether the mandate can be separated from the rest of the law back to the district court, requesting more analysis. Ultimately, if the courts find the mandate cannot be severed from the law, it would strike down the entirety of the ACA.
Without a replacement, wiping out the ACA would eliminate popular provisions including protections for pre-existing conditions.
The appeals court decision "leaves important health insurance protections shrouded in uncertainty despite overwhelming public support for these policies," American Medical Association President Patrice Harris said in a statement.
Legal experts said the decision Wednesday could create additional years of uncertainty.
More than 19 million Americans gained health coverage from 2010 to 2017 as the ACA went into effect, according to the Kaiser Family Foundation.
The Small Business Majority called the ruling a "grave mistake." Millions of small business owners and their employees rely on the exchanges for coverage, John Arensmeyer, the group's CEO, said in a statement.
"Creating additional uncertainty over the future of the ACA is a disaster for America's entrepreneurs: We are concerned this will cause a rapid rise in healthcare costs and create substantial economic instability," Arensmeyer said. He added that the ACA must be upheld to prevent further chaos and confusion in the healthcare system.
Despite the ruling that leaves the law in limbo, Americans' insurance coverage remains intact for now, Matt Eyles, CEO of America's Health Insurance Plans, noted in a statement. "The good news is today's decision will not affect anyone's coverage or care for the foreseeable future. Patients will continue to be covered for the care they need," he said.
California Attorney General Xavier Becerra who led the blue states' defense to uphold the law, said he plans to appeal the decision to the Supreme Court. "Let's end the uncertainty. Americans shouldn't be jerked around when it comes to their healthcare," Becerra wrote on Twitter.
If the high court decides to hear the case, it will not be the first time. The court ruled in favor of the individual mandate in 2012 but also said states had the option to choose whether they wanted to expand Medicaid.