Judge ruled that the entire ACA is unconstitutional
Texas vs USA
Covered CA and Blue Shield have announced that you can still enroll for January 1 through Friday the 21st of December. I expect the other companies will too, based on the mirroring law.
ACA Declared Unconstitutional * case stayed Court Listener * , so everything good for 2019
Department of Justice who is defending the case for the Federal Government, in their 49 page brief filed May 1, 2019 came to this conclusion!
The district court correctly held that the individual mandate is unconstitutional in light of the elimination of its penalty, that the guaranteed-issue and community rating provisions are inseverable from the mandate, and that the remainder of the ACA is inseverable in turn. Accordingly, the court’s judgment should be affirmed on the merits, except insofar as it purports to extend relief to ACA provisions that are unnecessary to remedy plaintiffs’ injuries.
Boy, that’s a convoluted mouthful. Here’s Health Affairs.org reporting
DOJ had taken a highly unusual position in Texas by declining to defend the constitutionality of the mandate and major provisions of the ACA that protect people with preexisting conditions. These provisions are guaranteed issue, community rating, the ban on preexisting condition exclusions, and discrimination based on health status.
The injury is that these rules “limit choices in the insurance markets that both plaintiffs would prefer.”
The court ruled (view 55 page ruling) that the law’s individual mandate could not be severed from the rest of President Barack Obama’s landmark healthcare law.
Leaning on the U.S. Supreme Court decision that the ACA is a tax, U.S. District Judge Reed O’Connor said that the entire law was invalidated by the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty.
In his ruling, O’Connor said that in both 2010 and 2017 Congress knew that the individual mandate couldn’t be severed from the popular coverage protections and guaranteed issue. The Trump administration had declined to defend the healthcare law and asked the judge to eliminate its guarantee of coverage for people with preexisting health conditions.
A spokesperson for California Attorney General Xavier Becerra said defendant states will appeal the decision. The case will now go to the U.S. Court of Appeals for the Fifth Circuit. Modern Health Care 12.14.2018 * Los Angeles Times * CA Health Line – and more reporting *
For the reasons stated above, the Court grants Plaintiffs partial summary judgment and declares the Individual Mandate, 26 U.S.C. § 5000A(a), UNCONSTITUTIONAL. Further, the Court declares the remaining provisions of the ACA, Pub. L. 111-148, are INSEVERABLE and therefore INVALID. The Court GRANTS Plaintiffs’ claim for declaratory relief in Count I of the Amended Complaint. Page 55 *
Covered CA – says don’t worry about this ruling for 2019 EastCountyToday * The judge did not issue an injunction ordering the government to stop carrying out the law, however, meaning that its provisions will remain in effect pending further action. “We will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan,” Seema Verma, the administration’s top official overseeing the law, said in a statement. Los Angeles Times *
View latest Status on the Case
Because many everyday Americans would otherwise face great uncertainty during the pendency of appeal The Court finds that the December 14, 2018 Order declaring the Individual Mandate unconstitutional and inseverable should be stayed. 30 page order *
ACA Provisions that could be out
- The ACA’s system of premium subsidies for low- and moderate-income households;
- Medicaid Medi-Cal MAGI – no asset test expansion
- young people to stay on their parents’ health plans up to age 26;
- a narrowing of the “doughnut hole” that saddles some Medicare enrollees with higher costs for prescription drugs.
- pre-existing medical conditions from being turned away for insurance or charged higher premiums than the general population.
Here’s my extraction of what I feel is the crux of the case where Texas asks the Federal Court to declare the ACA unconstitutional. Here’s Commonwealth Funds. USA Federal – Response to Texas Application to have ACA no longer enforceable 6.7.2018
In the Affordable Care Act (ACA), Pub. L. No. 111-148, 124 Stat. 119 (2010), Congress fundamentally altered the American health-insurance system by imposing a “[r]equirement” for most Americans “to maintain minimum essential coverage.” 26 U.S.C. § 5000A(a). In light of the basis on which the Supreme Court previously held that this “individual mandate” survived constitutional scrutiny, the United States agrees with the Plaintiffs that Section 5000A(a) must now be struck down as unconstitutional in light of the amendments that were made to it in the Tax Cuts and Jobs Act (TCJA), Pub. L. No. 115-97, 131 Stat. 2054 (2017).
the United States explained to the Court in NFIB, Congress’s own “findings establish that the guaranteed-issue §2701 and community-rating provisions [no charge for Pre Existing Conditions 45 CFR §147.108 The preexisting conditions clause prohibits insurers from refusing coverage to people with prior illnesses, or charging them more because of it.] are inseverable from the minimum coverage provision.” Br. for Resp’t (Severability) at 45, NFIB, No. 11-393 (citing 42 U.S.C. § 18091(2)(I)). The remainder of the ACA, however, can stand despite the invalidation of those provisions.
The remedy that Plaintiffs seek is also profoundly undemocratic. Plaintiffs ask this Court to impose an outcome by judicial fiat that Congress rejected through the legislative process.
Since the ACA became law in 2010, ACA opponents in Congress have tried—unsuccessfully—to repeal it at least 70 times. But the fact that Congress (through the Senate) voted down each of those efforts leads to one unavoidable conclusion: the Congress that passed the ACA, the Congress that passed the Tax Cuts and Jobs Act (TCJA), and every Congress in between, has decided to leave nearly every provision of the ACA in place, choosing instead to modify one provision reducing the future tax penalty for individuals who do not maintain health insurance. That reflects the will of the people, as expressed through their democratically elected representatives over multiple election cycles. There would be an enormous human cost from invalidating the ACA. Lastly, a preliminary injunction would also disserve the public interest because it would upend the status quo and wreak havoc on the healthcare market for patients, providers, insurance carriers, and the federal and state governments. Court Filing
If the Pre X protections of ACA are struck down, what laws prior to ACA come back to life?
What alternatives are there?
What might Congress or CA do to protect those with Pre X conditions?
AB 1672 for Small Groups guaranteed coverage with 2 or more employees, including husband and wife as owners. Scroll down and view the Q & A on that page too. 6.15.2018 LA Times refers to 12 month guaranteed on Pre X. I’m not exactly sure which exact law they are talking about.
In fact, Californians would already be temporarily cushioned by existing state rules that protect people with preexisting conditions for 12 months [Citation Needed] if that portion of the Affordable Care Act is struck down. Try below about Federal HIPAA.
One example might be the MacArthur Amendment that requires states to set up a program for High Risk Individuals.
See our main page on Pre X and check out the HISTORICAL section
Earlier Briefs & Filings
View on Pacer * Court Listener * Order May 16, 2018 The motion is ripe for review. Having considered the motion, briefing, and applicable law, the Court finds that the Proposed Intervenor States’ Motion to Intervene (ECF No. 15) should be and is hereby GRANTED for the reasons stated below. BRIEF OF PLAINTIFFS – Texas (with our comments, highlights, annotations) IN SUPPORT OF APPLICATION FOR PRELIMINARY INJUNCTION 4.26.2018 Texas V US Memorandum Opinion & Order 3.5.2018 Complaint for Declaratory & Injunctive Relief 2.26.2018
Plaintiffs ask this Court to preliminarily enjoin the entire Patient Protection and Affordable Care Act (ACA), a landmark piece of legislation that has enabled more than 20 million Americans to gain health coverage, has restructured nearly one-fifth of the national economy, and has become central to the healthcare system of our country over the past eight years. Court Filing
An estimated 50 to 130 million Americans have preexisting conditions, such as arthritis or diabetes. If the Trump administration has its way, insurers could deny coverage or charge higher premiums to consumers with preexisting conditions in the individual market or exclude their preexisting conditions from coverage, unless prohibited by state law.
CBS News – ACA Unconstitutional
No Injunction – So, good for 2019
CNN Report on ACA Ruling – Unconstitutional
Trump’s Flip Flop Washington Post 6.14.2018