(RNN) - A federal judge’s opinion that the Affordable Care Act is unconstitutional could be the start of a legal battle that leads to the Supreme Court again deciding on the healthcare law.
For now, nothing changes. People who enrolled for health insurance before Dec. 15 will still be covered under their plan, and others can still enroll in states that extended the deadline. Provisions in the law, like protections for people with pre-existing conditions, remain in place.
Also continuing is the Medicaid expansion in states that chose to opt in, including recent additions like Virginia. The ACA, also known as Obamacare, will still be the law pending appeals of the decision, said the White House in a statement.
Federal District Judge Reed O’Connor in Fort Worth, TX, said Friday the ACA could not be severed from the individual mandate, which Republicans effectively eliminated in the 2017 tax cut bill. The mandate penalized people above a certain income level if they didn't have health insurance.
O’Connor said in his ruling he would not parse the ACA’s provisions individually, instead invalidating the entire law.
The case was brought by attorneys general from Texas and 19 other states, and the Justice Department under President Donald Trump chose not to defend the law in court. A group of 16 states, including California, and the District of Columbia intervened to defend, and they announced soon after the ruling they would appeal.
The attorney general in Maryland filed a lawsuit against the Trump administration to protect the ACA and asked a federal judge to declare it constitutional.
What happens if Obamacare is dissolved?
The ACA was far-reaching legislation that caused changes across the healthcare industry.
Among the areas affected if Obamacare goes away:
- Insurance companies could deny coverage to people with pre-existing illnesses (diabetes, cancer, rheumatoid arthritis, etc.) or severely increase the cost of insurance. The nonprofit Kaiser Family Foundation said 52 million people in the U.S. had pre-existing conditions that would prevent them from getting coverage.
- There would no longer be any cost regulations preventing premium increases based on age or other factors.
- Children would not be able to stay on their parents' insurance until age 26.
- Medicare recipients would no longer get relief from prescription drug costs through the closing of the Part D “donut hole.”
- The federal exchange, as well as most or all state exchanges, where people can compare health insurance and purchase it, would go away, as would the subsidies to help people afford it.
- People who purchased insurance through the exchanges could lose their plans, as well as those covered under the Medicaid expansion.
The outcome of the law is uncertain, as multiple legal scholars questioned the judgment. Valarie Blake, a health law professor at West Virginia University, called O'Connor's (a President George W. Bush appointee) decision baffling and political in nature.
Jonathan H. Adler, a conservative law professor at Case Western Reserve University, told The New York Times the judge’s conclusion was "hard to justify" and "surprisingly weak."
How did we get here?
The ACA has been a constant target for the GOP since it passed in 2010, and a case challenging the legality made its way to the Supreme Court in 2012. In a 5-4 decision, Chief Justice John Roberts, a George W. Bush appointee, joined the four Democratic-appointed justices in declaring the individual mandate legal under Congress' ability to impose taxes.
Dozens of bills to repeal the law passed by the GOP-led House were done as symbolic gestures while President Barack Obama was in office. With Republicans taking control of Congress and the White House in 2017, they decided to forgo a full repeal.
Efforts at partial repeal-now-replace-later plans failed in the Senate in 2017, and no alternative for the ACA has ever been presented by conservative lawmakers or the president, beyond broad outlines.
Arguments on the 2018 case before O'Connor happened in September. In November, Democrats successfully took control of the House by flipping 40 seats, with many running on a platform of protecting or strengthening the ACA.
Republicans running for office across the country softened their stance on the healthcare, pledging to protect the most popular aspects of the law. Top GOP members of Congress have been slow to react to the judge's ruling, including House Speaker Paul Ryan.
"The House was not party to this suit, and we are reviewing the ruling and its impact," said a spokeswoman for Ryan to the Associated Press.
Trump applauded the judge’s decision Friday on Twitter and called for Congress to pass a “strong” healthcare law.