Access to Care

Texas v. Azar Decision


Late on Friday, Dec. 15, a federal district court in Texas struck down the Affordable Care Act (ACA) in its entirety, finding that the 2017 Tax Cuts and Jobs Act (TCJA), which zeroed out the tax penalties associated with the ACA’s individual mandate, renders the mandate unconstitutional. The judge further concluded that since the individual mandate is “essential” to the ACA, it could not be severed from the rest of the ACA, and the entire ACA was therefore unconstitutional. 

While the Texas district court decision was unfortunate, it is important to keep it in perspective.  The court did not issue an injunction, so immediate compliance is not required. In addition, the Trump Administration announced that it will continue to administer the law until a formal decision is made by the U.S. Supreme Court, which will not occur until 2020 at the earliest, after additional legal steps are completed.

Nonetheless, the atmosphere of uncertainty created by this decision on top of other steps taken by Congress and the Administration will likely contribute further to the instability of the individual insurance market. 

For physicians and patients it is important to recognize that, if the district court’s ruling were to stand, many important and broadly supported patient protections provided by the ACA would be eliminated, such as:

  • 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

Further, the nearly 20 million individuals who became insured since the ACA’s passage would be left with few affordable coverage options.

The AMA disagrees strongly with the district court’s decision. We led an amicus brief filed last June that urged the court to reject the plaintiffs’ challenge to the ACA. Other organizations that joined the AMA in filing the brief included the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry. 

The AMA will continue to be a champion for access to affordable and meaningful health insurance coverage for all Americans, joining patient and other health stakeholder groups in pursuing an appeal and reversal of this regrettable decision.