News that a Texas judge has ruled the Affordable Care Act unconstitutional sent ripples of concern, anger, celebration and confusion ... depending on the viewpoint ... through the country. While most legal pundits, political leaders and industry associations agree the ruling will have no immediate effect as the case winds it way through the legal system, the impact would be widely felt if the decision were ultimately upheld.
The opinion handed down by Texas U.S. District Court Judge Reed O'Connor hinged on the individual mandate that was eliminated in the new tax laws passed by Congress at the end of 2017. 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.
The decision, which sided with 18 Republican state attorneys and two GOP governors, was handed down the day before open enrollment in the ACA exchange closed for 2019. A group of 16 Democratic state attorneys general who fought the measure immediately vowed to appeal. Two previous challenges to the ACA have already gone before the Supreme Court, and the expectation is that this case will work its way to the high court, as well.
President Donald Trump responded to the decision with a tweet:
"As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!"
Other responses are as follows:
Rick Pollack, American Hospital Association President & CEO:
"America's hospitals and health systems are extremely disappointed with today's federal district court ruling on the constitutionality of the Affordable Care Act. The ruling puts health coverage at risk for tens of millions of Americans, including those with chronic and pre-existing conditions, while also making it more difficult for hospitals and health systems to provide access to high-quality care.
We strongly disagree with the ruling and urged the court not to accept the plaintiff's severability argument in an amicus brief filed earlier this year along with other national organizations representing hospitals and health systems. We join others in urging a stay in this decision until a higher court can review it and will continue advocating for protecting patient care and coverage."
Barbara McAneny, MD, American Medical Association President:
"Today's decision is an unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections and other policies that have extended health insurance coverage to millions of Americans," said AMA president Barbara L. McAneny, M.D. "It will destabilize health insurance coverage by rolling back federal policy to 2009. No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections, but this decision will move us in that direction."