A federal appeals court has ruled that the Affordable Care Act’s individual mandate is unconstitutional and sent the case, Texas v. United States, back to a lower court for a more detailed analysis of what parts of the law should remain valid in the mandate’s absence. This action prolongs the uncertainty over the health reform law’s status that started a year ago when the same lower court judge ruled that the entire law was unconstitutional. While the Supreme Court might decide take up the case right away instead of allowing it to go back to the district court, it will be months or even years before a final judgement—and the law remains in effect as it makes its way through the courts, so things on the ground for patients and practitioners won’t be changing soon.
Invalidating the entire law would mean as many as 20 million people could lose coverage through the ACA’s Marketplaces and the Medicaid expansion. It would also affect people with job-based insurance who stand to lose protection against annual and lifetime caps, young adults on their parents’ plans, seniors with high Medicare drug costs, federal agencies conducting payment reform experiments, funding for patient-centered research, and more. A narrower ruling striking only the parts of the law most closely tied to the individual mandate—the pre-existing condition protections and essential health benefits (EHBs)—would still be highly disruptive to millions of people, who would lose protections they have come to expect, and states, which would have to rebuild their health insurance markets. Striking the EHBs would mean losing the guarantee that individual market plans must cover rehabilitative and habilitative services and devices.
AOTA is following the case closely. Check this blog for updates on the status of the health care reform law and states’ efforts to prepare for the possibility of a post-ACA world.
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