The ACA Goes to Court Again (and again, and again…)

I’ve been enjoying a few days at my parents house after an exam and it’s given me a chance to catch up on the nitty gritty health policy news of the past few months. And hoo boy, is there a lot going on. Congress might be in recess until after the election, but that doesn’t mean things are slowing down in the health policy arena!

Today we’re taking a look at two lawsuits that could have an immense impact on the future of the ACA. The Texas v. Azar lawsuit, which was filed in February 2018 by Texas and 19 other states, builds on the repeal of the individual mandate tax penalty by the Tax Cuts and Jobs Act of 2017. The lawsuit argues that because this tax penalty was reduced to $0 in 2019 by the 2017 tax legislation, the individual mandate will become unconstitutional. Since the ACA is dependent on the mandate, the lawsuit calls for the ACA to be invalidated by the court. After the U.S. Justice Department declined to defend the ACA in this lawsuit, Democratic state attorneys general from 16 states and D.C. were allowed to intervene on behalf of the law.

During oral argument on September 5, 2018, Judge Reed O’Connor focused much of his questioning on congressional intent and severability. At the end of the three hours of argument, Judge O’Connor seemed less than convinced that the mandate–with the repeal of the penalty–remained constitutional. At this stage in the judicial proceedings, the plaintiffs are seeking a preliminary injunction against some or all of the ACA. The Justice Department has asked the court to delay a ruling until the close of the December open enrollment period. It is expected that any ruling will be appealed immediately.

Any ruling from this lawsuit stands to have an immense impact on the health of millions of individuals. According to a report from the Urban Institute, more than 17 million individuals will lose health insurance coverage in 2019 if the ACA is invalidated. That would be equal to a 50% increase in the number of uninsured individuals in just one year. Striking down the ACA would also greatly imperil coverage for the 12 million low-income individuals who have benefited from Medicaid expansion.

In response to Texas v. Azar, the Maryland Attorney General has filed a lawsuit with the U.S. District Court of Maryland seeking a declaratory judgement that the ACA is constitutional and that the Trump Administration must stop trying to sabotage the law. Examples of this sabotage include drastically reducing the funding for navigator groups who assist in insurance enrollment, an expansion of skimpy short-term health plans, and a serious cutback to open enrollment advertising.  In defending the success and importance of the ACA, the Maryland lawsuit points out that nearly 100,000 state residents have secured private insurance due to the ACA and that uncompensated care costs have fallen by $300 million.

With only 15 days to go until the 2018 midterm elections, health care remains a top issue for voters. A recent Kaiser poll reported that 71% of voters indicated that health care is “very important” when deciding how to cast their ballot. As the New England Journal of Medicine has stated, access to health insurance provides “significant, multifaceted, and nuanced benefits to health.” As we progress past the midterms and the imminent ruling in Texas v. Azar, we’ll keep you up to date about their impacts on health coverage around the country.

Image from The Brookings Institution.

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