US judge rules Obamacare unconstitutional
A federal judge in Texas on Friday ruled that the Affordable Care Act is unconstitutional now that Congress has eliminated a penalty for those who forgo health insurance, casting doubt on the embattled health law and coverage for millions of Americans.
U.S. District Judge Reed O’Connor, an appointee of President George W. Bush, ruled that the entire Obama-era health law is invalid, siding with the claims of 20 Republican statesthat brought a lawsuit seeking to strike down the ACA.
Republicans eliminated the ACA’s penalty for not having coverage last year, although the measure doesn’t go into effect until 2019. Mandatory health coverage was a linchpin of the original law, intending to draw healthier people into the insurance pool to help offset the costs of sicker enrollees. The Supreme Court has upheld the ACA as constitutional based on Congress’s taxing power.
The Trump administration, which has long sought to repeal the ACA, applauded Friday’s ruling.
“Wow, but not surprisingly, ObamaCare was just ruled UNCONSTITUTIONAL by a highly respected judge in Texas. Great news for America!” President Trump wrote on Twitter. In a statement, the White House elaborated, saying, “Once again, the President calls on Congress to replace Obamacare and act to protect people with preexisting conditions and provide Americans with quality affordable healthcare.”
Friday’s decision rattled top Democratic politicians, medical groups and health-industry leaders. Some advocacy groups called on Congress to immediately pass legislation protecting coverage for people with pre-existing conditions, and the American Medical Association vowed to work with other organizations in seeking an appeal.
“This is a five alarm fire-Republicans just blew up our health care system,” Sen. Chris Murphy (D., Conn.) said in a statement. “The anti-health care zealots in the Republican Party are intentionally ripping health care away from the working poor, increasing costs on seniors, and making insurance harder to afford for people with preexisting conditions.”
The ruling, while invalidating the law, didn’t immediately block enforcement of the ACA, a situation that could trigger widespread uncertainty in the near term. Some states could stop enforcing or administering the law, including Medicaid expansion, starting Jan. 1, when the elimination of the penalty takes effect.
Democratic states that had intervened in the lawsuit said they would quickly seek an appeal to the Fifth U.S. Circuit Court of Appeals. Ultimately, the case could reach the Supreme Court. The decision Friday thrust the future of the 2010 law on unstable terrain just before the busiest final days for sign-ups during the ACA’s open-enrollment period.
“It will destabilize health-insurance coverage by rolling back federal policy to 2009,” said Barbara McAneny, president of the American Medical Association.
Organizations that oppose the ACA said they supported the decision. The law, they said, has amounted to heavy government intrusion into health care and limited choice for consumers.
“Although Republicans in Congress have failed to repeal Obamacare in its entirety, this ruling has proven that their action to repeal the individual mandate in last year’s tax reform legislation was a consequential move,” according to a statement Friday from FreedomWorks, which advocates for smaller government.
The lawsuit, which was first dismissed as largely frivolous when it was filed in February, represents the biggest risk to the ACA since the Republican effort to repeal the law in 2017. Led by Texas Attorney General Ken Paxton, the lawsuit seeks to undo the entire health law that has become deeply intertwined in the U.S. health system.
That includes Medicaid expansion, subsidies for about 10 million people who buy health insurance on the ACA’s individual markets, requirements on employer-provided health coverage and new industry taxes. An estimated 20 million people gained coverage, mostly through Medicaid expansion and the ACA exchanges, since October 2013, according to a 2016 report from the Department of Health and Human Services.
“Today’s ruling is an assault on 133 million Americans with pre-existing conditions, on the 20 million Americans who rely on the ACA’s consumer protections for health care, on America’s faithful progress toward affordable health care for all Americans,” said California Attorney General Xavier Becerra, who intervened with other Democrats in the case.
A deeply divided Supreme Court upheld the ACA in 2012, treating the insurance penalty as a tax and ruling that such a tax was within Congress’s power.
With the tax no longer in place starting in 2019, the insurance mandate can no longer be upheld on that basis and is now unconstitutional, Judge O’Connor said Friday. And because the mandate is so central to how the entire ACA operates, the whole law must fall, the judge said.
In a move that stunned even many congressional Republicans, the Justice Department had also asked the court to invalidate key planks of the ACA. Those provisions include consumer protections such as the prohibition barring insurers from denying coverage to people with pre-existing conditions.
Democrats seized on the request in the November election campaign to portray Republicans as threatening the health coverage of an estimated 52 million Americans with pre-existing health conditions. Some congressional Republicans have introduced legislation and a House resolution aimed at preserving some pre-existing-coverage protections.
Democrats are worried about the case winding up before the Supreme Court, and many have vowed to pursue legislation next year enshrining the law’s protections for people with pre-existing conditions.
“Now with Judge Brett Kavanaugh on the Supreme Court, we have a justice who supports the president’s efforts to undermine the law he’s supposed to implement and protect,” said Margarida Jorge, executive director of Health Care for America Now, an advocacy group that backs the ACA.
Judge O’Connor had to weigh whether the Republican states had proper legal standing to even challenge the law and whether a penalty-free insurance mandate is unconstitutional-and if so, what parts of the law should be struck down.
“The individual mandate is so interwoven with the ACA’s regulations that they cannot be separated. None of them can stand,” the judge wrote in a 55-page opinion.
An ideological cross section of legal experts questioned whether the ruling would stand up on appeal, especially given that Congress’s action in 2017 left most of the law in place.
The ruling also strikes at the ACA markets’ newfound stability-heading into 2019, premiums haven’t been spiking sharply, as in past years, and insurers were expanding their footprints, after previous withdrawals.
Because insurers have already signed on the dotted line to offer plans next year and locked in their rates, they likely can’t make changes until 2020. But as the case moves forward through higher courts, insurers will need to be weighing their offerings for 2020-first filings are due in some states in late spring.
“If this awful ruling is upheld in the higher courts, it will be a disaster for tens of millions of American families, especially for people with pre-existing conditions,” said Sen. Chuck Schumer (D., NY).
Source: The Wall Street Journal
