Texas Hold 'Em - Will It End the ACA?

So here we are. On Friday night, Texas federal Judge Reed O’Connor ruled the ACA unconstitutional because the individual mandate was no longer being enforced. Once again, millions of Americans are being threatened with the loss of affordable health care.

As expected, and perhaps more strongly than ever before, people are jumping to the law’s defense:

  • CA Attorney General Xavier Becerra denounced the ruling and is leading the appeal process.

  • Maryland’s Attorney General, Brian Frosh is also entering the fray and vows to defend the law.

  • Hordes of trade groups, including the American Medical Association, are stunned by the decision.

  • Legal experts on both sides of the political divide have expressed surprise at the ruling and have said the legal rationale behind the ruling is “indefensible, and breaks a long standing legal principle of not throwing the baby out with the bathwater by tossing out an entire law because of one small piece of it, as discussed in the New York Times this weekend.

If the ruling is upheld, millions of people risk losing their healthcare if pre-existing conditions are no longer covered, or being able to afford comprehensive healthcare at all. But the ACA does far more than that:

  • It would remove oversight of the FDA approval for biosimilar drugs.

  • It puts the future of the CMS Innovation Center, which is working to shift the entire healthcare system towards new payment models in doubt. Maryland is a high profile model in the program.

  • It would invalidate the Medicaid expansions, throwing millions of Americans off Medicaid, and would also invalidate Medicaid coverage for children aging out of foster care, expansion of Medicaid community care options for long-term services, and simplification of Medicaid eligibility.

  • It could affect the Indian Health Service which was resurrected under the ACA, as well as a database which scrutinizes payments to doctors from big Pharma and device companies.

This will almost certainly go to the Supreme Court. In the meantime, the law is still in effect, and will be through 2019.