FLASH!!!

Judge ruled that the entire ACA is unconstitutional

Texas vs USA

View latest Status on the Case
Court Listener.com 

The case is expected to be heard in January 2021 (Coronavirus delays?) in the Supreme Court.

Learn More

New York Times 6.26.2020 

NY Mag.com 7.13.2020  

Kaiser Foundation 3.10.2020

Modern Health Care 3.2.2020

 

The 5th U.S. Circuit Court of Appeals in New Orleans * Opinions * This opinion 198 pages * ruled that the individual mandate is not constitutional because it cannot be construed as a tax.  The case goes back to U.S. District Judge Reed O’Connor in Texas to determine whether the rest of the law can be saved. Modern Health Care 12.19.2019 * LA Times 12.15.2019 *

Obamacare survives to fight another day.  Careless judicial interference has the potential to be especially pernicious when it involves a complex statute like the ACA, which carries significant implications for the welfare of the economy and the American populace at large.  APPELLATE JUDGE CAROLYN DINEEN KING   LA Times 12.19.2019 *

USA Today, striking down ACA/Obamacare would open a path to better more affordable care 12.12.2019

Trump’s held office for 3 years – no sign of replacement plan  LA Times 12.30.2019 *

Commonwealth Fund 12.19.2019 * Kaiser Foundation 11.27.2019 Potential impact of key provisions

July 11, 2019 Kaiser Health News – ending the ACA would also create chaos in other parts of the health care system that were directly or indirectly changed under the law’s multitude of provisions, such as calorie counts on menus, a pathway for approval of generic copies of expensive biologic drugs and, perhaps most important politically, protections for people with preexisting conditions.

June 27, 2019

Who has standing to sue – standing to intervene, bring the case to court?  Some legal experts said the request did not bode well for the future of President Barack Obama’s signature domestic policy achievement.  More generally, this order suggests that the Fifth Circuit panel may be hostile to the ACA and inclined to support the red states If the 5th Circuit upholds the lower-court ruling — which would almost certainly put it back in front of the Supreme Court — it would create a political and logistical mess for the Trump administration and Congress. Republicans repeatedly failed to repeal and replace Obamacare while they controlled both the House and the Senate in 2017 and have little appetite to revisit health reform. Read more at:  Washington Post  *  Politico Washington Post *

 

***********

DOJ won’t defend or appeal the ruling ACA/Obamacare is unconstitutional and says everything should be scrapped, then start over.  Los Angeles Times * NPRModern Health CareCNBC

Because many everyday Americans would otherwise face great uncertainty during the pendency of appeal The Court finds that the December 14, 2018 Order declaring the Individual Mandate unconstitutional and inseverable should be stayed. 30 page order *

Notice of Appeal 1.3.2019 * CA Attorney General states he’s going to stand up for the law of the land, keep the no pre x clause in the law.

ACA Provisions that could be out

  • The ACA’s system of premium subsidies for low- and moderate-income households;
  • Medicaid Medi-Cal MAGI – no asset test expansion
  • young people to stay on their parents’ health plans up to age 26;
  • a narrowing of the “doughnut hole” that saddles some Medicare enrollees with higher costs for prescription drugs.
  • pre-existing medical conditions from being turned away for insurance or charged higher premiums than the general population.

If the Pre X protections of ACA are struck down, what laws prior to ACA come back to life?

 

What alternatives are there?

 

What might Congress or CA do to protect those with Pre X conditions?

 

AB 1672 for Small Groups guaranteed coverage with 2 or more employees, including husband and wife as owners. Scroll down and view the Q & A on that page too. 6.15.2018 LA Times  refers to 12 month guaranteed on Pre X. I’m not exactly sure which exact law they are talking about.

In fact, Californians would already be temporarily cushioned by existing state rules that protect people with preexisting conditions for 12 months [Citation Needed] if that portion of the Affordable Care Act is struck down.  Try below about Federal HIPAA.

Mr. MIP and PCIP High Risk Pools – might come back Association plans? CA Single Payer SB 562 See our website on TrumpCare.

One example might be the MacArthur Amendment that requires states to set up a program for High Risk Individuals.

See our main page on Pre X and check out the HISTORICAL section

Get Instant Individual & Family Quotes including Subsidy Calculation
Get Instant Individual & Family Quotes including Subsidy Calculation

Open Enrollment till January 31st

Click here for Special Enrollment Opportunities

Extensive Video explanation of how to use all features of our quote engine

Latest Status

SUMMARY

Department of Justice who is defending the case for the Federal Government, in their 49 page brief filed May 1, 2019 came to this conclusion!

The district court correctly held that the individual mandate is unconstitutional in light of the elimination of its penalty, that the guaranteed-issue and community rating provisions are inseverable from the mandate, and that the remainder of the ACA is  inseverable in turn.  Accordingly, the court’s judgment should be affirmed on the merits, except insofar as it purports to extend relief to ACA provisions that are unnecessary to remedy plaintiffs’ injuries.

 

Boy, that’s a convoluted mouthful.  Here’s Health Affairs.org reporting

DOJ had taken a highly unusual position in Texas by declining to defend the constitutionality of the mandate and major provisions of the ACA that protect people with preexisting conditions. These provisions are guaranteed issue, community rating, the ban on preexisting condition exclusions, and discrimination based on health status.

The injury is that these rules “limit choices in the insurance markets that both plaintiffs would prefer.”

As examples of non-injurious ACA provisions, the DOJ points to the ACA’s amendment of certain criminal statutes for health care fraud and anti-kickback violations.   May 2, 2019 * March 26 * April 12 *

The court ruled (view 55 page ruling)  that the law’s individual mandate could not be severed from the rest of President Barack Obama’s landmark healthcare law.

Leaning on the U.S. Supreme Court decision that the ACA is a tax, U.S. District Judge Reed O’Connor said that the entire law was invalidated by the 2017 Tax Cuts and Jobs Act, which zeroed out the individual mandate penalty.

In his ruling, O’Connor said that in both 2010 and 2017 Congress knew that the individual mandate couldn’t be severed from the popular coverage protections and guaranteed issue.  The Trump administration had declined to defend the healthcare law and asked the judge to eliminate its guarantee of coverage for people with preexisting health conditions.

A spokesperson for California Attorney General Xavier Becerra said defendant states will appeal the decision. The case will now go to the U.S. Court of Appeals for the Fifth Circuit. Modern Health Care 12.14.2018 *  Los Angeles Times * CA Health Line – and more reporting *

CBS News – ACA Unconstitutional
No Injunction – So, good for 2019

CNN Report on ACA Ruling – Unconstitutional

Crux of the Case 

Main Point

Here’s my extraction of what I feel is the crux of the case where Texas asks the Federal Court to declare the ACA unconstitutional.  Here’s Commonwealth Funds. USA Federal – Response to Texas Application to have ACA no longer enforceable  6.7.2018

In the Affordable Care Act (ACA), Pub. L. No. 111-148, 124 Stat. 119 (2010), Congress fundamentally altered the American health-insurance system by imposing a “[r]equirement” for most Americans “to maintain minimum essential coverage.” 26 U.S.C. § 5000A(a). In light of the basis on which the Supreme Court previously held that this “individual mandate” survived constitutional scrutiny, the United States agrees with the Plaintiffs that Section 5000A(a) must now be struck down as unconstitutional in light of the amendments that were made to it in the Tax Cuts and Jobs Act (TCJA), Pub. L. No. 115-97, 131 Stat. 2054 (2017).

the United States explained to the Court in NFIB, Congress’s own “findings establish that the guaranteed-issue §2701 and community-rating provisions [no charge for Pre Existing Conditions 45 CFR §147.108   The preexisting conditions clause prohibits insurers from refusing coverage to people with prior illnesses, or charging them more because of it.] are inseverable from the minimum coverage provision.” Br. for Resp’t (Severability) at 45, NFIB, No. 11-393 (citing 42 U.S.C. § 18091(2)(I)). The remainder of the ACA, however, can stand despite the invalidation of those provisions.

CA Xavier Becerra – INTERVENOR-DEFENDANTS’ BRIEF IN OPPOSITION to stopping the ACA from being law 6.7.2018

The remedy that Plaintiffs seek is also profoundly undemocratic. Plaintiffs ask this Court to impose an outcome by judicial fiat that Congress rejected through the legislative process.

Since the ACA became law in 2010, ACA opponents in Congress have tried—unsuccessfully—to repeal it at least 70 times. But the fact that Congress (through the Senate) voted down each of those efforts leads to one unavoidable conclusion: the Congress that passed the ACA, the Congress that passed the Tax Cuts and Jobs Act (TCJA), and every Congress in between, has decided to leave nearly every provision of the ACA in place, choosing instead to modify one provision reducing the future tax penalty for individuals who do not maintain health insurance. That reflects the will of the people, as expressed through their democratically elected representatives over multiple election cycles.  There would be an enormous human cost from invalidating the ACA. Lastly, a preliminary injunction would also disserve the public interest because it would upend the status quo and wreak havoc on the healthcare market for patients, providers, insurance carriers, and the federal and state governmentsCourt Filin

Case CONCLUSION

For the reasons stated above, the Court grants Plaintiffs partial summary judgment and declares the Individual Mandate, 26 U.S.C. § 5000A(a), UNCONSTITUTIONAL. Further, the Court declares the remaining provisions of the ACA, Pub. L. 111-148, are INSEVERABLE and therefore INVALID. The Court GRANTS Plaintiffs’ claim for declaratory relief in Count I of the Amended ComplaintPage 55 *

Covered CA – says don’t worry about this ruling for 2019 EastCountyToday *  The judge did not issue an injunction ordering the government to stop carrying out the law, however, meaning that its provisions will remain in effect pending further action.  “We will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan,” Seema Verma, the administration’s top official overseeing the law, said in a statement.  Los Angeles Times *

Earlier Briefs & Filings

View on Pacer  *  Court Listener  * Order May 16, 2018 The motion is ripe for review. Having considered the motion, briefing, and applicable law, the Court finds that the Proposed Intervenor States’ Motion to Intervene (ECF No. 15) should be and is hereby GRANTED for the reasons stated below. BRIEF OF PLAINTIFFS – Texas (with our comments, highlights, annotations) IN SUPPORT OF APPLICATION FOR PRELIMINARY INJUNCTION 4.26.2018 Texas V US  Memorandum Opinion & Order 3.5.2018 Complaint for Declaratory & Injunctive Relief 2.26.2018

Plaintiffs ask this Court to preliminarily enjoin the entire Patient Protection and Affordable Care Act (ACA), a landmark piece of legislation that has enabled more than 20 million Americans to gain health coverage, has restructured nearly one-fifth of the national economy, and has become central to the healthcare system of our country over the past eight years.  Court Filin

 

News Reports

An estimated 50 to 130 million Americans have preexisting conditions, such as arthritis or diabetes. If the Trump administration has its way, insurers could deny coverage or charge higher premiums to consumers with preexisting conditions in the individual market or exclude their preexisting conditions from coverage, unless prohibited by state law.

The ACA provisions the Trump administration asked the court to invalidate affect all forms of private health coverage — individual, small group, large group, and self-insured employer plans.
 
If the ACA is invalidated, protections under the prior law, the Health Insurance Portability and Accountability Act, would likely come back into force.   Under that law, they would prohibit your employer from refusing to cover you or charging you more because of a preexisting condition, but your employer plan could refuse to cover preexisting conditions for up to a year if you failed to maintain continuous coverage.  CNN  6.14.2018 *  CNN 3.1.2018

30 comments on “California vs Texas Supreme Court – ACA unconstitutional

  1. Biden’s health plan is largely organized around restoring, strengthening, and expanding the system in place under the Affordable Care Act (ACA). Through rulemaking, the US Department of Health and Human Services under the Biden administration might be expected initially to roll back much of the deregulation and regulatory changes made during the President Donald J. Trump era, restoring programs and policies to the way they were interpreted or implemented based on ACA statute.

    https://www.chcf.org/wp-content/uploads/2020/11/WhatsNextHealthCarePolicyBidenAdministration.pdf
    issue brief  biden

  2. Will this verdict that’s going on the 10th going to drastically affect premiums for 2021?

    Is this going to get rid of The subsidies?

    Or is that just something that’s still up in the air?

    • Here’s my excerpts of the review of the case from Kaiser Foundation. I’m not an attorney nor have a crystal ball

      The ACA remains in effect while the litigation is pending.

      Looking Ahead

      If the Supreme Court finds that the individual mandate is unconstitutional and invalidates only that provision, the practical result will be essentially the same as the ACA exists today, without an enforceable mandate.

      What about California’s Mandate? https://individuals.healthreformquotes.com/individual-mandate/

      invalidates the individual mandate as well as the protections for people with pre-existing conditions, then federal funding for premium subsidies and the Medicaid expansion would stand, and it would be up to states whether to reinstate the insurance protections.

      if the Supreme Court ultimately decides that all or most of the ACA must be overturned, as the federal government now argues.

      For now, the ACA remains in effect. the Trump Administration has indicated that it intends to continue enforcing the ACA while the appeal is pending. Although the Supreme Court’s decision in the case could come as late as June 2021, the Court’s decision to review the case now, without waiting for the lower courts to complete their review, will minimize the amount of time that the ACA’s future remains uncertain.

      the only certainty for the ACA in the foreseeable future is that there is continuing uncertainty about its ultimate survival.

      However, if all or most of the law ultimately is struck down, it will have complex and far-reaching consequences for the nation’s health care system, affecting nearly everyone in some way. it would be enormously complex to disentangle these provisions from the overall health care system.

      including protections for people with pre-existing conditions, https://individuals.healthreformquotes.com/aca/pre-existing-conditions/

      subsidies to make individual health insurance more affordable, https://individuals.healthreformquotes.com/subsidies/intro/aptc/

      expanded eligibility for Medicaid, https://medi-cal.healthreformquotes.com/eligibility/

      coverage of young adults up to age 26 under their parents’ insurance policies, https://employers.healthreformquotes.com/ab-1083/definitions/employer/employee/dependent-definition/

      coverage of preventive care with no patient cost-sharing, https://individuals.healthreformquotes.com/aca/essential-benefits/preventative-care/

      closing of the doughnut hole under Medicare’s drug benefit, and https://medicare.healthreformquotes.com/part-d-rx/donut-hole/

      a series of tax increases to fund these initiatives.

      the federal government took what the 5th Circuit called a “significant change in litigation position”7 by deciding to support the trial court’s decision that the individual mandate is inseverable from the entire ACA.

      the federal government does not want the Court to necessarily prevent it from still enforcing parts of the law. Instead, the federal government is seeking a more limited remedy: it contends that “relief should reach only the enforcement of the ACA provisions that injure the individual plaintiffs.”11 The federal government has not clearly identified which specific ACA provisions fall into this category and is asking the Supreme Court to send the case back to the lower courts to determine this issue.12

      Finally, if the entire ACA is held invalid, the Court will resolve whether the entire law should be unenforceable nationwide or whether it should be unenforceable only to the extent that provisions injure the individual plaintiffs.

      The case will be argued at the Supreme Court on November 10, 2020. The Court has allotted one hour and twenty minutes for oral argument, with 40 minutes for each side. California will argue for 30 minutes of the time allotted to the parties defending the ACA, with the remaining 10 minutes argued by the House.

      https://www.kff.org/health-reform/issue-brief/explaining-california-v-texas-a-guide-to-the-case-challenging-the-aca/

  3. If the ACA is overturned, the consequences could be severe. At this point, the nation remains mired in the coronavirus pandemic, which has metastasized into one of the greatest public health crises in a century. Last week, the US reached the horrific milestones of more than 7 million people infected and 200,000 dead from COVID-19. ACA protections for people with preexisting conditions would disappear if the health law is struck down, and more than 12 million adults who have gained health coverage through the ACA’s Medicaid expansion could lose it. More than 9 million others would lose access to subsidized premiums for private health insurance.

    Still, the worst-case scenario is just one of many. Here is a review of the lawsuit, what’s at stake, and the potential outcomes. https://www.chcf.org/blog/this-legal-attack-aca-could-be-big-one/

  4. This fact sheet highlights the key health coverage gains made in California under the state’s robust implementation of the Affordable Care Act (ACA) since it was enacted over 10 years ago on March 23, 2010. These achievements show how much is at stake in California v. Texas, the case the Supreme Court is scheduled to hear on November 10, 2020, under which the ACA could be overturned.[1] https://laborcenter.berkeley.edu/californias-health-coverage-gains-under-the-affordable-care-act-whats-at-stake-in-california-v-texas/

  5. This will need to be tattooed to the foreheads of all of the Republicans who both passed the tax law changes intending this result, and all of the Red State Republicans who joined the lawsuit. No more hiding behind election year lies that they are the ones who really want to protect Americans’ health care.

  6. Summary of today’s argument – Oral Argument

    modernhealthcare.com/article/20180905/NEWS/180909977

    https://reason.com/volokh/2018/09/06/meanwhile-in-a-texas-courtroom-is-the-ac

    https://www.ajmc.com/newsroom/texas-hearing-against-aca-wraps-up-as-senators-tie-issue-to-kavanaugh

    Although it is risky to try to predict the outcome of a case from oral argument, Judge O’Connor’s questions… suggest he may be considering striking down some or all of the ACA.”

    Jost came away with a similar conclusion: “The devastating consequences of his potential decision in the case before him were of no interest to Judge O’Connor, who showed no sign of having read the amicus briefs filed by virtually every stakeholder in the American health care system — doctors, hospitals, insurers, patient groups, consumer organizations, small businesses, older Americans, as well as numerous health economists and public health experts — demonstrating those consequences.”
    https://www.chcf.org/blog/high-stakes-game-texas-hold-em-millions-lose-coverage/

  7. So, what’s the latest for the 2019 renewal? Where are we at? Will my coverage be renewed even though I have Pre X conditions?

    • We’ve just received notice from Covered CA, even though you might be direct with an Insurance Company, Covered CA still controls everything.

      Rates for 2019 are going up an average of 8.7% and all 11 Insurance Companies will still be offering plans.

      Manual rate charts should be available in the next few weeks. Our Quote engine should have the rates ONLINE soon after that.

      Watch for updates on each Insurance Companies page

Leave a Reply

Your email address will not be published.