The headlines on Friday evening blared the news: “Texas Judge Strikes Down the Affordable Care Act.” In Texas v. Azar, a federal judge ruled that when Congress reduced the tax penalty for being uninsured to $0 it made the entire ACA unconstitutional. This didn’t mean that the many programs and policies that can be traced to the 2010 health reform law had to shut down immediately: on Saturday, the final day of open enrollment for the ACA’s marketplaces in most states was allowed to proceed. And on Monday, the Secretary of the U.S. Department of Health and Human Services (HHS) released a statement saying that the agency would continue to enforce the law. The full statement is below:
“The recent U.S. District Court decision regarding the Affordable Care Act is not an injunction that halts the enforcement of the law and not a final judgement. Therefore, HHS will continue administering and enforcing all aspects of the ACA as it had before the court issued its decision. The decision does not require that HHS make any changes to any of the ACA programs it administers or its enforcement of any portion of the ACA at this time. As always, the Trump Administration stands ready to work with Congress on policy solutions that will deliver more insurance choices, better healthcare, and lower costs while continuing to protect individuals with pre-existing conditions.”
For a detailed explanation of the judge’s decision, read this analysis at the Health Affairs journal blog: Federal Judge Strikes Down Entire ACA; Law Remains in Effect.
The consensus seems to be that it could take many months, if not years, to reach a final judgement in Texas v. Azar. The ACA survived Supreme Court challenges in 2012 (NFIB v. Sebelius, which upheld the law but made the Medicaid expansion optional) and 2015 (King v. Burwell, which upheld the law’s subsidies), and now it could be headed back for another round. In the meantime, it will be important for us to think about what unwinding the entire law might mean.
The ACA is the subsidized health insurance marketplace/exchanges and the Medicaid expansion; the pre-existing condition protections; and the ban on annual and lifetime caps in both individual and employer-sponsored plans. It’s the guarantee of essential health benefits (EHBs), including rehabilitation and habilitation, for people who rely on the individual market for health insurance. It’s the Center for Medicare and Medicaid Innovation (CMMI), Medicare Accountable Care Organizations (ACOs) and bundled payment projects. It’s the ability to stay on a parent’s plan until age 26. It’s closing the Medicare prescription drug donut hole. It’s comparative effectiveness research. It’s preventive care without cost-sharing. And much more (the Kaiser Family Foundation has a summary of the law’s provisions).
AOTA will be following the case closely. Check this blog for updates and links to helpful resources.
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