While President Trump issued a 'never mind' on the DOJ's March 25 announcement - effectively reversing the reversal of the White House position on the Texas ACA ruling - stakeholders impacted by the potential dissolution of the Affordable Care Act continue to be concerned over where the DOJ will land on the topic and what the courts will ultimately decide.

On April 1, the AMA filed an amicus brief to defend ACA gains. Below is information with a link to the brief:

In defense of significant coverage gains and key patient protection provisions of the Affordable Care Act (ACA), the American Medical Association (AMA) and other leading physician organizations today filed an amicus brief in the case of Texas v. United States. Additional organizations joining the AMA include the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), and the American Psychiatric Association (APA). Download or view the amicus brief .

"The district court ruling that the individual mandate is unconstitutional and inseverable from the remainder of the ACA would wreak havoc on the entire health care system, destabilize health insurance coverage, and roll back federal health policy to 2009," said AMA President Barbara L. McAneny, M.D. "The ACA has dramatically boosted insurance coverage, and key provisions of the law enjoy widespread public support. The district court's decision to invalidate the entire ACA should be reversed."

If the district court ruling is upheld, it would adversely impact every single American, rendering the following ACA provisions null and void:

• Patients would no longer have protections for pre-existing conditions
• Children would no longer have coverage under their parents' health insurance plan until age 26
• Insurers would no longer be held to the 85% medical loss ratio, meaning they could generate higher profits at the expense of coverage and payments for services
• 100 percent coverage for certain preventive services would cease
• Individual marketplace and subsidies based on income would be eliminated
• Federal funding for Medicaid expansion would end, as would Medicaid eligibility expansion
• Annual and life-time dollar limits could be reinstated, leading to more bankruptcies due to health care costs

For more than a decade, the AMA has advocated for expanded coverage and key health insurance reforms that help patients. At the time of the ACA's passage and ever since, the AMA has acknowledged that the law has flaws and policymakers need to fix problems, gaps, and unintended consequences. The AMA's highest priority is to ensure that the millions of Americans who have gained health care coverage because of the law maintain their coverage, in addition to their patient protections.

Prior Coverage from Late March:

On March 25, the Department of Justice announced a reversal of its previous position regarding the Affordable Care Act, now saying the courts should strike down the entire law.

The most recent twist in the legal wrangling over the ACA came back in December when Texas U.S. District Court Judge Reed O'Connor ruled the ACA unconstitutional after Congress struck down the individual mandate. An earlier Supreme Court decision upheld the ACA based on the government's right to tax citizens, and the judgement that the individual mandate penalty was, indeed, a tax and therefore within the power granted Congress by the Constitution. With the penalty eliminated, Judge O'Connor opined the ACA no longer met that mandate and was therefore rendered entirely unconstitutional as he deemed the individual mandate to be 'essential to' and 'inseverable from' the overall law. That decision sided with 18 Republican state attorneys and two GOP governors who were suing over the law's pre-existing conditions protections.

Despite his ruling, O'Connor issued a stay so that the Affordable Care Act would remain in place as is until such a time as the appeals process over his ruling had run its course ... effectively shoving the issue to the back burner during Open Enrollment period. However, the DOJ's new, broader position that the whole law should go returns the issue to the spotlight. At stake are insurance coverage for millions of Americans, payment policies and innovations under Medicare and a string of other provisions throughout healthcare tied to ACA.

Stakeholders have begun to release statements about the latest twist as they contemplate the ramifications of overturning the ACA without any replacement plan on the table.

Rick Pollack, President and CEO
American Hospital Association

America's hospitals and health systems oppose the Department of Justice's (DOJ) misguided decision calling on the courts to strike down the Affordable Care Act in its entirety. The position is unprecedented and unsupported by the law or the facts. Millions of Americans would lose the coverage they have relied on for years. We have made too much progress in coverage and access to care for patients to go backwards.

If courts were to adopt the DOJ position, Medicaid expansion would be reversed and protections for people with chronic and pre-existing conditions would cease to exist.