Ruling Puts Affordable Care Act Back into Play

Federal District Judge Reed O’Connor again thrust the Affordable Care Act (ACA) into uncertainty with his December 14 ruling that concluded that eliminating the tax penalty for not having insurance renders the entire law unconstitutional. Among the takeaways from this ruling:

  • Because Judge O’Connor did not issue an injunction after ruling the ACA unconstitutional, supporters of the law cannot file immediately for an appeal. The process will be more complicated.
  • Although conservative legal scholars likely might agree with the judge that the mandate to have coverage cannot stand without the penalty — based on Chief Justice John Roberts’ landmark ruling in the first challenge to the law — many did not expect that other broad aspects of the ACA would also be thrown out in this case.
  • Although the issue will play out in the courts, Congress will face pressure on how to handle the decision. Lawmakers could easily remedy this situation by, for example, instituting a one-cent penalty against people who don’t have insurance. But finding consensus on a plan forward looks difficult.
  • Much of the focus by the public after the decision has been on the 10 million people who buy insurance through the ACA marketplaces and the 12 million who are covered through their states’ Medicaid expansion (including Iowa). But the law has much broader reach, including protections for people with preexisting conditions, an end to lifetime caps for all consumers, allowing children to remain covered by the parents’ insurance until age 26, requirements on how much of their revenue insurers must spend on customers’ coverage and efforts to improve quality at hospitals, nursing homes and doctors’ offices.

It’s fair to say that the ACA, and therefore this ruling, impacts all Americans and the people and organizations that provide our health care. So it’s no surprise that health care provider organizations, patient advocates and consumer protection advocates have uniformly condemned the ruling.