Our Director of Government Affairs, Alexis Denny, recently provided the following memo on a federal district court judge’s decision in the case of Texas vs US regarding the Affordable Care Act (ACA):

On December 14, 2018, a federal district court judge struck down the entire 2000-page Affordable Care Act (ACA).

In his decision in the case of Texas v US, Judge Reed O’Connor held that ACA’s individual mandate, which required everybody to have health insurance, was unconstitutional. He held that, because the individual mandate was too central of ACA, the entire law was illegal. The decision most likely will be appealed and eventually should be considered by the US Supreme Court.

For the time being, ACA will remain in effect during future appeals, and the decision will have little immediate impact on patients. If the decision eventually is upheld on appeal, several key patient protection provisions will disappear. These include:

• Requiring health insurance policies to cover 10 essential health benefits;
• Covering people with preexisting conditions at reasonable rates;
• Expanding Medicaid eligibility; 37 states are using this provision;
• Out of pocket savings for consumers in the Medicare Part D drug “donut hole”;
• Covering children on parents’ insurance until age 26;
• Providing some no-cost preventive services such as vaccines, mammograms, and certain screenings.

Shortly after the 116th Congress convenes on January 3, 2019, the House is expected to vote to join the lawsuit in support of ACA. House committees, which will have a Democratic majority, will work on separate legislation to protect the preexisting conditions provisions and related issues.

How the Republican-controlled Senate responds to the Texas decision and future House action cannot be determined at this early date. Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) may reintroduce their bill to give states more flexibility while retaining ACA’s consumer protections.

Please keep an eye out for more news as it becomes available.