As most people know by now, on Friday night, a federal judge in Texas relied on a flimsy legal argument to declare the entire Affordable Care Act unconstitutional. The opinion works a violation of separation of powers and misapplies settled law. For more on the merits, please see my op-ed with Jonathan Adler (who opposed the A.C.A. in both previous Supreme Court challenges, so that should tell you something about the weakness of this opinion).
Here, I want to make crystal clear the jaw-dropping human consequences of the decision.
The A.C.A. is long: 2,000+ pages long. And by now many people probably have forgotten what it was like to get insured before the A.C.A, or mistakenly think the A.C.A. only helps poor people. The A.C.A. does so much more. It’s time to remember all the things the law adds, so we know what is now potentially lost and so the appellate courts, the public, and Congress understand what’s at stake.
You probably remember the A.C.A. has a lot of insurance reforms. But you may not realize that you benefit from many of these provisions even if you get coverage through your employer and even if you don’t get your plan on the A.C.A. insurance markets.
Thanks to the decision, gone would be the following insurance protections, and many more:
Here are some other A.C.A. insurance benefits you may now take for granted and not realize from whence they came:
And then of course we lose the expansion of Medicaid.
Medicaid has already covered some 15 million extra Americans. Even those who had Medicaid before the ACA would lose the advantages of the simplifications brought by the ACA (those simplifications have increased Medicaid enrollments even in states that have not expanded coverage). In total, roughly 20 million fewer people are estimated to lose access to care, including the care Medicaid provides to treat the opioid epidemic. Children in foster care also would lose the additional coverage the A.C.A. extended for them as they transition into adulthood.
Don’t forget Medicare.
The A.C.A. also offered advances in public health, which will now be lost, including:
Other good government reforms that make healthcare affordable and accessible would be gone too, including:
Take a step back absorb how much this decision affect. Most of these reforms have nothing to do with the insurance-purchase mandate the judge opined was so central to the entire 2,000+ pages of the A.C.A. that nothing in those pages could function without it. But more importantly, Congress never said a thing about eliminating all of these provisions-- indeed, Congress failed more than 50 times in attempts to repeal them. Congress only eliminated the mandate penalty, leaving the rest of the law still standing. As we have explained, the legal test at issue turns entirely on what Congress intended. The judge’s opinion effectively repeals the entire A.C.A. when Congress couldn’t and didn’t.
The A.C.A. affects all Americans, not just those with lower incomes. Most of us have employer coverage and have also benefited from the law. Most of us, with some luck, will be on Medicare and would benefit from the A.C.A’s payment reforms and expanded drug coverage. Many of us will need the biologic drugs, or the mental health services, maternity converge or cancer screening or vaccines that the A.C.A. makes accessible.
Of course, Friday’s decision will certainly be appealed and so the court’s ruling is not the final word. And the effects of the decision are most likely to be paused while any appeal is pending, so the devastating implications of the decision laid out here are not immediate, and hopefully will never come to pass.
As Adler and I wrote, an opinion with these kinds of vast human consequences based on anything other than rock-solid legal ground is not just irresponsible; it is contrary to the rule of law.