Patient Support & Advocacy

Controversial ACA ruling: 4 things physicians should know

In the days since a federal judge’s ruling striking down the Affordable Care Act (ACA) in its entirety, there has been a flood of punditry on the merits of the decision and its potential impact. While that makes fun reading for some, for others without law degrees it can be a bit overwhelming. So here are four key things that practicing physicians should understand and share with patients who ask.

Keep it in perspective. While the ruling, from the U.S. District Court for the Northern District of Texas, is unfortunate, it’s important to put it in context.

This Texas v. United States decision was based on the court’s finding that the 2017 Tax Cuts and Jobs Act—which zeroed out the tax penalties associated with the ACA’s individual mandate—renders the mandate unconstitutional. The judge further concluded that since the mandate was an essential part of the ACA, the entirety of the law is unconstitutional.

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About AMA’s amicus brief to defend patients’ ACA coverage

Sounds dire. Does that mean the 20 million people who became insured since the ACA’s passage are now out of luck? Definitely not, because the court did not issue an injunction, so that means the law stands for now.

In addition, the Trump administration announced that it will keep administering the law until the U.S. Supreme Court weighs in on the matter. And that won’t happen until 2020 at the earliest, because other legal steps need to take place first.

Physicians are fighting to uphold patient protections. The AMA led the filing of an amicus brief in the case, joined by other physician organizations such as the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry. 

As AMA President Barbara L. McAneny, MD, wrote at the time, “For well over a decade, the AMA’s message has been clear: we stand firmly with patients, committed to expanding coverage and protecting them from insurance industry abuses. Our work to support and defend the ACA is also reflective of our mission to improve the health of our nation. The evidence is clear: patients without insurance live sicker and die younger.”

Reacting to the Texas v. United States ruling, Dr. McAneny declared, “No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections.”

Learn more about the AMA vision on health care reform.

It’s not great for the individual insurance market. This decision—which comes on top of other steps already taken by Congress and the administration—will probably further destabilize the individual insurance market.

That having been said, patients were able to enroll for ACA marketplace plans again this year. And the Kaiser Family Foundation (KFF) reported that the average cost of a benchmark silver plan premium was down 1.5 percent for 40-year-olds. In most states, uninsured Americans and people interested in exploring their coverage options for 2019 had until Dec. 15 to enroll on HealthCare.gov.

But you should know there are some exceptions to that deadline, as follows:

  • Massachusetts—Dec. 23.
  • Rhode Island—Dec. 31.
  • New York—Jan. 31, 2019.

Why this matters for you and your patients. If this decision were to pass muster with the U.S. Supreme Court, many important and broadly supported patient protections provided by the ACA would be eliminated. These include:

  • Access to their parents’ plan coverage for young adults up to age 26.
  • Elimination of annual and lifetime caps on benefits.
  • No pre-existing condition coverage exclusions or medical underwriting.
  • Coverage of prevention and screening benefits with no deductibles or copayments.
  • Required coverage for mental health and addiction treatment services.
  • Federal support for expanded Medicaid eligibility.
  • Premium subsidies for low- and moderate-income individuals and families to purchase coverage and cost sharing subsidies to lower out-of-pocket costs.

If you would like to wade into the legal punditry waters behind this case, consider this essay, “Texas v United States: The Affordable Care Act is Constitutional and Will Remain So,” published at the JAMA Forum blog by Lawrence O. Gostin. He is faculty director of the Georgetown University Law Center’s O’Neill Institute for National and Global Health Law.

Gostin writes: “The case will certainly be appealed, and the outcome is virtually assured. ... In fact, if Texas v. United States does find its way to the Supreme Court, I predict a solid court majority will find the law severable, and thus constitutional.”