Access to Care

AMA stands up for ACA patient protections in federal court

Andis Robeznieks , Senior News Writer

To help defend and maintain the significant coverage gains patients have benefited from because of the Affordable Care Act (ACA), the AMA filed an amicus brief opposing a ruling that struck it down.

In Texas v. United States, Federal Northern Texas District Judge Reed O’Connor ruled in December that the individual mandate to carry health insurance was unconstitutional after the 2017 Congress changed the tax penalty to zero dollars and so, therefore, was the rest of the law. The U.S. Department of Justice told the 5th U.S. Circuit Court of Appeals last week that it agreed with the entirety of that decision and would no longer defend the ACA in court.

If the decision is allowed to stand, 20 million people could lose their coverage and the ACA would be discarded without a plan ready to replace it.

“The district court ruling that the individual mandate is unconstitutional and inseverable from the remainder of the ACA would wreak havoc on the entire health care system, destabilize health insurance coverage, and roll back federal health policy to 2009,” said AMA President Barbara L. McAneny, MD. “The ACA has dramatically boosted insurance coverage, and key provisions of the law enjoy widespread public support. The district court’s decision to invalidate the entire ACA should be reversed.”

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The brief describes “the havoc that striking the entire ACA would cause to the entire U.S. health care system” and also demonstrates “that, under proper analysis, the individual mandate is severable from the remaining provisions of the ACA.”

The brief also shows that Congress intended all other ACA health care provisions to stay in force when it eliminated the individual mandate tax penalty. Those provisions include:

  • Subsidies to low-income Americans who purchase health insurance on exchanges established under the ACA.
  • Payments to states for voluntary expansion of their Medicaid programs.
  • Required coverage of “essential health benefits” and preventive services.
  • Required coverage of people with preexisting conditions.

“Nothing indicates that the 2017 Congress intended these provisions to be struck down because the tax on non-compliance with the individual mandate was reduced to zero,” the brief says. “Rather, these provisions are fundamental to the delivery of high-quality, affordable care in this country.”

No plan for replacing the ACA has been publicly released. The Democrats recently unveiled a package of bills aimed at lowering individual market premiums, expanding ACA navigator and outreach activities, and funding to help states establish their own individual insurance marketplaces.

“The AMA believes that these bills would help to reduce consumers’ health care costs and improve their access to high quality insurance coverage,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a letter to leaders of the House Energy and Commerce Committee.

Learn more about the AMA’s vision on health care reform.

Republicans have not yet publicly released a plan to replace the ACA, but Sen. Susan Collins, R, Maine, wrote a letter to Attorney General William Barr explaining why she disagreed with the DOJ action, which she said puts at risk several “critical consumer provisions.”

Collins wrote that it was “implausible” that Congress intended for these protections to be eliminated when it reduced the individual mandate penalty to zero.

“If Congress had intended to eliminate these consumer protections along with the individual mandate, it could have done so,” she wrote. “It chose not to do so. Rather than seeking to have the courts invalidate the ACA, the proper route for the administration to pursue would be to propose changes to the ACA or to once again seek its repeal.”

The AMA’s highest priority is that the millions who have gained coverage under the ACA do not lose it. It has also acknowledged that the ACA has problems that need to be fixed, such as gaps in coverage.

The organizations joining the AMA in the brief are the: American Academy of Allergy, Asthma and Immunology, American Academy of Family Physicians, American Academy of Pediatrics, American Association of Child and Adolescent Psychiatry, American Association of Public Health Physicians, American College of Correctional Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, American College of Radiation Oncology, American Geriatrics Society, American Medical Women’s Association, American Osteopathic Association, American Psychiatric Association, American Society of Hematology, American Society for Metabolic and Bariatric Surgery, GLMA: Health Professionals Advancing LGBTQ Equality, and the Renal Physicians Association.