Dec 15, 2018
by Ed Lamb
First, don’t panic.
Even though a federal district judge in Texas ruled the entire Affordable Care Act unconstitutional, all plans and enrollments now in place for 2019 will be honored. Spokespeople for the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services are all telling reporters some version of “There is no impact to current coverage or coverage in a 2019 plan.”
Second, expect major upheavals to ACA rules, subsidies and federal health initiatives leading up to open enrollment next year. Federal officials, members of Congress, insurers and employers must start preparing for the possibility that the system constructed over the past decade to implement so-called Obamacare will cease to exist.
U.S. District Court Judge Reed O’Connor declared in Texas et al. v. United States of America that no provision of or program under the ACA could be enforced or continued. He reasoned the following:
- Congress removing the tax penalty on individuals for not carrying health insurance made the ACA unconstitutional because
- The U.S. Supreme Court originally upheld the constitutionally of the ACA on the grounds that tax penalty existed, and
- With the one provision being “inserverable” for the rest of the law, no part of the law could remain in effect.
Vox notes that that this decision will be quickly appealed. Further,
Most legal experts … are skeptical of the arguments made in this case -- even those that have worked on other legal challenges to the Affordable Care Act. They say that it willfully ignores the intent of the 2017 Congress, which zeroed out the individual mandate penalty without touching the rest of the Affordable Care Act.
Should the ruling stand, the U.S. health insurance market may return to its status quo ante of no Medicaid expansion, no federal subsidies for the purchase of health plans on the open market, no essential coverage rules, and no rules that all people who select the same plan get charged the same premium and deductibles regardless of sex, age, or health status.
Perhaps most concerning for many benefits administrators and health care consumers would be the elimination of the rule that insurance companies make their plans available to people with preexisting conditions.
If that happens, panic.