Insurance coverage is still on the line for millions of Americans, after a federal appeals court ruled that the Affordable Care Act’s requirement that Americans carry health insurance is unconstitutional.
The law remains in effect for now, but the 2-1 ruling handed down by a panel of the 5th U.S. Circuit Court of Appeals in New Orleans last month means the ultimate fate of the rest of the Affordable Care Act including such popular provisions as protections for those with pre-existing conditions, Medicaid expansion and the ability for children under the age of 26 to remain on their parents' insurance remains unclear, according to the Associated Press.
The panel agreed with Texas-based U.S. District Judge Reed O’Connor’s 2018 finding that the law’s insurance requirement, the so-called “individual mandate,” was rendered unconstitutional when Congress, in 2017, reduced a tax on people without insurance to zero.
The court reached no decision on the issue, which is how much of the Affordable Care Act must fall along with the insurance mandate.
“It may still be that none of the ACA is severable from the individual mandate, even after this inquiry is concluded. It may be that all of the ACA is severable from the individual mandate. It may also be that some of the ACA is severable from the individual mandate, and some is not," Judge Jennifer Elrod wrote.
The decision sends the case back to a judge who already ruled once to throw out the entire ACA but with some guidance.
O'Connor has to be more specific about which parts of the law can't be separated from the mandate, and also must take into account Congress' decision to leave the rest of the law essentially unchanged when it reduced the penalty for not having insurance to zero, Elrod wrote.
In dissent, Judge Carolyn Dineen King said her colleagues were prolonging “uncertainty over the future of the health care sector.” King would have found the mandate constitutional, although unenforceable, and would have left the rest of the law alone.
California Attorney General Xavier Becerra, who is leading state efforts to defend the law, promised a quick appeal to the Supreme Court.
"For now, the president got the gift he wanted – uncertainty in the health care system and a pathway to repeal – so that the health care that seniors, workers and families secured under the Affordable Care Act can be yanked from under them," Becerra said in a statement.
Attorney General Ken Paxton of Texas, which spearheaded the lawsuit seeking to throw out the ACA, applauded the court's decision to declare the mandate unconstitutional.
“As the court’s opinion recognized, the only reason the Supreme Court upheld Obamacare in 2012 was Congress’ taxing power, and without the individual mandate’s penalty that justification crumbled,” Paxton wrote. “We look forward to the opportunity to further demonstrate that Congress made the individual mandate the centerpiece of Obamacare and the rest of the law cannot stand without it."
President Donald Trump also applauded the decision, calling it a “win for all Americans.”
The court’s ruling ensures “Obamacare” will remain a political issue during the 2020 election campaign, giving Democrats a line of attack against Trump and congressional Republicans. With the health law’s ultimate fate still in doubt, Democrats will argue that Republicans are trying to strip coverage away from 20 million Americans.
Democratic House Speaker Nancy Pelosi called the ruling a “chilling threat" to those who rely on the Affordable Care Act.
All the Democratic presidential candidates favor expanding coverage to the remaining 27 million uninsured, although their ideas range from building on the Obama health law to replacing America’s mix of private and public insurance with a single plan run by the government.
The lawsuit followed congressional approval of a major tax cut in 2017, which included the reduction of the “Obamacare” tax on the uninsured to zero. The case came about because “Obamacare” opponents noted a splintered Supreme Court ruling of 2012 that upheld the law.
In that decision, conservative justices had rejected the argument that Congress could require that everyone buy insurance. But Chief Justice John Roberts, joining four liberal justices, said Congress did have the power to tax those without insurance.
With no tax in effect, the Texas lawsuit argued, the so-called “individual mandate” was unconstitutional and the entire law must fall. Judge O’Connor agreed in his December 2018 ruling.
Supporters of the law said the reduction of the tax penalty to zero could be read as a suspension of the tax, which didn’t render the mandate unconstitutional. They said the structure for collecting a penalty from the uninsured remained in place.
Congress had already failed to repeal the Affordable Care Act in its entirety, the law’s supporters noted. What happened in 2017, they contended in written arguments, is that Congress “chose to make the minimum coverage provision unenforceable — while leaving every other part of the ACA in place.”
What happens if the ACA is repealed?
More than 135 million people with preexisting conditions may no longer have their illnesses protected and millions may pay more for drugs, according to a press release from www.protectourcare.org, an outreach group working to stop the appeal of Obamacare.
More than 20 million Americans could lose their coverage and insurance companies would be able to sell policies that have to cover prescription drugs, cancer treatments or maternity care, according to the outreach group.
“This decision all but assures the entire health care law will be repealed,” Protect Our Care Chair Leslie Dach said in a press release. “The Fifth Circuit Court of Appeals sided with President Trump and Republicans in declaring a key portion of the ACA unconstitutional and sent the rest back to a judge who has already ruled the entire law unconstitutional. The fix is in. Thanks to Trump and Republicans, every part of the ACA is on the chopping block.”
“Make no mistake, this is Donald Trump’s health care plan. President Trump and Republicans own this lawsuit and all of its devastating consequences; kick people off their coverage, take protections away from people with pre-existing conditions, and line the pockets of insurance and drug companies. From start to finish, this was a partisan lawsuit with the sole purpose of ripping health care away from American families.”
Benefits that could be lost if the ACA is repealed according to Protect Our Care include:
- Medicaid expansion, which covers 17 million people.
- Nearly 12 million seniors will have to pay more for prescription drugs.
- Protections for older Americans that prevent them from being charged an “age tax.”
- Over two million adult children will no longer be able to stay on their parents’ insurance.
- Insurance companies will be able to charge women more than men.
- Financial assistance that helps 9 million people purchase health care in the marketplace will go away.
- Key support for rural hospitals will be eliminated. As Americans lose coverage, already struggling hospitals will be hit even harder as their costs increase.
- Ban on insurance companies having lifetime caps on coverage.
- Requirements that insurance companies cover prescription drugs and maternity care.
- Contraception coverage for 60 million people who now have access to birth control with no out-of-pocket costs.
Under the ACA, health plans must cover preventive services, such as flu shots, cancer screenings, contraception, mammograms, pap smears, annual doctor physicals and other preventative measures at no cost to consumers.
ACA in Coweta
Coweta has three options for medical care coverage under the ACA.
Kaiser, CareSource and Blue Cross Blue Shield are HMOs, or health maintenance organizations, which means a person must visit in-network doctors to avoid hefty added charges.
There is a Kaiser Permanente office on Newnan Crossing Bypass, but previously many “Obamacare” recipients had been forced to switch doctors because of the scarcity of plans in the area.
“CareSource is in-network with Piedmont Healthcare, with members’ access to the large scope of Piedmont Healthcare hospitals, surgery centers, primary care physicians, laboratory services, specialists and other health care practitioners,” according to a press release from CareSource.
House Minority Leader Rep. Bob Trammell, D-Luthersville, said hundreds of thousands of Georgians could be in danger of losing coverage.
Trammell represents District 132, which includes part of Coweta.
“On top of that, the 4.3 million Georgians with a pre-existing condition could once again be denied or dropped from coverage just because of their medical history,” Trammell said. “Health care experts and economists acknowledge that if the ACA is deemed unconstitutional and is no longer law, the results in our healthcare system will be quite chaotic.”
Trammell said constant uncertainty will be the new normal.
“Rather than working to dismantle and destroy the ACA, we need Republicans to work with Democrats to build upon the successes of the law, expand coverage and lower costs,” Trammell said.
Trammell also said if the ACA were repealed, “the stakes are certainly high.”
“The ACA has been under attack pretty much since its inception,” Trammell said. “It would be a great travesty to go back to the days when pre-existing conditions weren’t protected from omission by insurance companies. Literally millions of Americans could lose their health insurance.”
Kandice Bell, Newnan Times-Herald reporter, contributed to this story.
Associated Press reporters – Rebecca Santana, Mark Sherman and Ricardo Alonso-Zaldivar.