Update on ACA Lawsuit

The death of eminent Supreme Court justice Ruth Bader Ginsburg on September 18th brought renewed attention to the fate of the Affordable Care Act. As previously reported, a lawsuit challenging the constitutionality of the ACA (California v. Texas) is pending in the Supreme Court. Because Justice Ginsburg was considered a likely vote to uphold the ACA, in a divided court, her death gives rise to heightened concern over the possible outcome of the case. Here’s a refresher about the lawsuit, and a rundown of what we know for now.

Background. In 2018, a group of plaintiffs led by the Texas Attorney General sued to invalidate the ACA. Their argument hinges on a law Congress passed in 2017 that zeroed out the ACA’s individual mandate penalty: with the penalty set at $0, the plaintiffs argue, the ACA’s mandate for people to purchase health insurance can’t be considered a tax, and it is therefore unconstitutional. Furthermore, according to the plaintiffs, the individual mandate is so essential a part of the ACA that once it is struck down, the entire law must fall. Many legal experts (across the political spectrum) think these anti-ACA arguments are extraordinarily weak – and yet a trial court and an appeals court have so far largely sided with the plaintiffs. California v. Texas is now before the Supreme Court for review.

There is a lot at stake for people with bleeding disorders (and other serious health conditions). A sweeping ruling against the ACA in California v. Texas would end the ACA’s protections for individuals with pre-existing conditions. If the Court invalidates the ACA, health plans could once again deny people coverage or charge them much higher premiums based on their health status. Tax credits that help people buy insurance on the individual market would disappear, as would the requirement that health plans cover essential health benefits.

Such a ruling could also have an impact far beyond the individual insurance market and the ACA Exchanges. Large employers would no longer have to offer insurance to their employees. Health plans could re-introduce annual and/or lifetime caps on benefits; would not have to limit patients’ yearly out-of-pocket costs; would not have to allow parents to keep their children covered up to age 26; and more. The ACA’s Medicaid expansion would disappear, eliminating coverage for many millions of people in 36+ states – just as COVID-related job losses have made Medicaid coverage more important than ever. Provisions that save money for Medicare enrollees (such as those closing the Part D “doughnut hole”) would also expire.

Next steps? A major political battle has erupted over the Supreme Court seat formerly held by Justice Ginsburg. President Trump has nominated Judge Amy Coney Barrett to fill that slot; her nomination goes to the U.S. Senate for approval. Meanwhile, oral argument in California v. Texas is expected to take place as scheduled, on November 10, 2020, whether or not a new justice has been seated. Observers do not expect the Court to publish a decision in the case before Spring 2021.

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Source: Hemophilia Federation of America

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