A federal judge’s ruling on December 14 in Texas v. Azar that the Affordable Care Act is unconstitutional does not change 2019 health coverage protections of the ACA, health insurance coverage obtained through the annual marketplace open enrollment (which ended December 15) or automatic reenrollment, said Ryan Barker, vice president of Health Policy for the Missouri Foundation for Health.
“The most important thing is that people know that the ruling does not impact the law as of now. It doesn’t impact its insurance coverage for 2019,” Barker said. “If you enrolled, you should pay your bill because the coverage is still good.”
A small red bulletin near the top of the Healthcare.gov reads, “Court decision does not affect 2019 coverage or enrollment.”
The court case was filed by 20 Republican attorneys general, including Josh Hawley, then Missouri attorney general and now its U.S. senator-elect. They argued that because the individual mandate was upheld as a tax by the U.S. Supreme Court, when the new Republican federal tax law passed last year reduced the penalty for not having insurance coverage to zero, technically, the mandate still remains a part of the ACA. Judge Reed O’Connor of the Federal District Court in Fort Worth also ruled the individual mandate could not be separated from the rest of the Affordable Care Act; therefore the entire law had to be struck down.
“What this judge is saying is that by pretty much removing the individual mandate, you can’t separate it from the rest of the law, so he ruled the entire Affordable Care Act unconstitutional,” Barker said.
Barker said the ruling is a legal step – a process that will probably make its way to an appellate court or back to the U.S. Supreme Court.
“What’s important for folks to know is that this is a legal process – the judge did not enjoin the law… which means the ruling doesn’t automatically go into effect, which allows for appeals,” Barker said.
“If it would go to the Supreme Court, it’s not going to make it during this Supreme Court session, which means it would go to the Supreme Court next year, either late 2019 or 2020, and a ruling could come as late as June 2020.”
The constitutionality of the ACA was upheld in 2012 by the U.S. Supreme Court. Barker said the Texas judge quoted a dissenting opinion.
“The majority said that you could separate out different pieces of the law,” Barker said. That’s when Medicaid Expansion became optional for states. “What was interesting from this Texas judge’s opinion is that he was actually quoting from the minority opinion of that 2012 ruling of the Supreme Court – the minority of that ruling found that you couldn’t separate pieces of the law.”
Barker said it is unusual for a judge to quote the minority opinion of a Supreme Court ruling, and while legal scholars from liberals to conservatives are scratching their heads on this ruling, Barker said the judge is not an Obamacare fan.
“This judge in Texas has made it clear he is not a fan of the Affordable Care Act,” Barker said. “While there were a lot of folks thinking that case didn’t have a lot of chance, it is also not a huge surprise that this judge ruled this way.”
Dozens of patient advocacy groups have denounced the judge’s decision, including American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association and National Multiple Sclerosis Society.
“This decision threatens to resurrect barriers to health care for people with serious illnesses including cancer, heart disease, stroke, lung disease, diabetes and those with neurological conditions. If the ruling stands, anyone with a pre-existing condition could be charged more for health coverage or denied access to coverage altogether,” they stated.
“Health plans would no longer be required to offer essential benefits necessary to prevent and treat a serious condition and could once again impose arbitrary annual and lifetime limits on coverage. Invalidating the law also would jeopardize the federal tax credits that make health insurance affordable for more than 8 million Americans, threatening their access to critical health coverage. Negating the law’s patient protections could put the health and well-being of millions of Americans at risk, just as we are beginning to see the benefits of expanded access to quality coverage.”
They encouraged the United States Court of Appeals for the Fifth Circuit to “support individuals with chronic diseases and preserve health care for millions of Americans” in the event of an appeal.
Democratic attorneys general and other defendant states plan to appeal the decision. Attorney General-elect Kwame Raoul of Illinois will continue that effort.
“The district court’s decision jeopardizes healthcare access for more than one million Illinoisans, including children, seniors and people with pre-existing conditions,” Raoul stated. “Upon taking office, I will continue our current attorney general’s work by partnering with attorneys general around the country to challenge this ruling and fight for the healthcare access Illinoisans need and deserve.”
A coalition of state attorneys general, including current Illinois Attorney General Lisa Madigan, intervened in the case to defend the ACA when its constitutionality was challenged.
While healthcare access is at risk for 133 million Americans with pre-existing conditions and 11.8 million people who have purchased health insurance through ACA exchanges for 2018, the law remains in effect pending further legal action.
Final figures are not in on this year’s 2019 Marketplace enrollment numbers, although they were running about 10 percent lower by the beginning of December, Barker said. Although open enrollment is over, special enrollment periods are available for individuals and families with life-change events.
“If you get married, have a baby, change jobs, and you lose your insurance or you need insurance for a new member of your family, there are still special enrollment periods, where you have 60 days to sign up,” Barker said. “We have in-person assisters that can help people, and there is still a Missouri-specific call center where you can call and get an appointment and they will help you find a location in your neighborhood where you can go and get free, in-person assistance.”
That number is 1-800-318-2596.
For more information, visit healthcare.gov.
