What’s the news: The U.S. Department of Justice told the 5th U.S. Circuit Court of Appeals that it agreed with a December 2018 court ruling that the entire Affordable Care Act (ACA) was invalidated without the individual insurance mandate penalty holding it together.
Why it matters for patients and physicians: This means the Justice Department won’t defend any part of the law in court. If Northern Texas District Judge Reed O’Connor’s ruling in Texas v. United States stands and the ACA is thrown out, then a host of patient protections go with it.
These include:
- Guaranteed coverage of pre-existing conditions.
- Coverage for 12 million people via Medicaid expansion.
- Coverage for young adults up to age 26 through their parents’ health plan.
- Contraceptive coverage.
- Coverage for substance-use disorders and essential benefits.
- The ACA health insurance marketplaces.
- The end of annual and lifetime limits on out-of-pocket costs.
- The end of CMS authority to test or develop new payment models.
About 20 million people could lose their health insurance if the ruling stands. The evidence is clear: Patients without insurance live sicker and die younger. That’s why the AMA and several other medical societies joined in an amicus brief supporting the ACA in this court case. Learn more about the AMA’s vision on health care reform.
What’s next: This is just one step in a legal process that will almost certainly wind up before the U.S. Supreme Court, so there is no imminent threat to these key patient protections. Tell your patients to rest assured, for now.
Meanwhile, leaders in the U.S. House of Representatives this week laid out a package of improvements to the ACA, a move the AMA is commending.
“The task now is to build on what has been shown to work and continue to make improvements where needed,” said AMA President Barbara L. McAneny, MD. “Working through the existing framework, we can extend the ACA’s reach and ensure coverage for millions more Americans.”
To stay on top of the latest developments in this case and other key issues affecting physicians, subscribe to the AMA’s Advocacy Update email newsletter.
