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Appellate judges rule ACA individual mandate unconstitutional


The ruling left physician groups concerned that their patients will face continued uncertainty about their insurance coverage

A key provision of the Affordable Care Act (ACA), requiring all Americans to buy health insurance or face a tax penalty, was ruled unconstitutional December 18 by a panel of appellate judges, but the fight over the controversial healthcare law is likely to drag on for at least? another year.

While the decision will have no immediate effects on the healthcare insurance coverage since the tax penalties associated with the mandate were reduced to $0 in the 2017, the fate of the rest of the law is in doubt.

In a 2-1 decision by the U.S. Court of Appeals for the Fifth Circuit in New Orleans, the majority chose to return the case to Judge Reed O’Connor in the Federal District Court in Fort Worth, Texas, to determine whether the mandate can be severed from the rest of the law. In 2018, O’Connor ruled the ACA was unconstitutional because of how central the mandate was to the law, according to a report from The New York Times.

O’Connor’s previous ruling based on Congress’s belief when it enacted the ACA that the individual mandate was a key element to the law that could not be severed from it. He found the mandate unconstitutional because a 2012 Supreme Court decision upheld the mandate, saying that it fell under Congress’ powers over taxation, according to the Times.

When the tax penalty was eliminated in 2017, 20 state attorneys general, the plaintiffs in the case, argued that defense of the law was no longer effective and that the rest of the law should be invalidated along with it. The Department of Justice refused to defend the law, and later joined the plaintiffs in arguing against the law, according to the Times.

O’Connor must now decide which provisions of the law can stand without the individual mandate.

Following the ruling, President Donald J. Trump released a statement calling it a “win for all Americans.”

“My Administration continues to work to provide access to high-quality healthcare at a price you can afford, while strongly protecting those with pre-existing conditions,” he says in the statement.

Democratic president hopeful Elizabeth Warren responded to the decision on Twitter.

“The Trump administration has abandoned its duty to defend the ACA in court and is cheering on efforts to destroy protections for pre-existing conditions, coverage for kids up to age 26, Medicaid expansion and more,” she says. “My administration will expand health care, not destroy it.”

Groups such as the American Medical Association (AMA), American College of Physicians (ACP), and the American Academy of Family Physicians (AAFP) reacted far less positively to the ruling. In a trio of news releases Dec. 19, each group, who had filed a joint brief with the district and appeals courts in support of the ACA, expressed their concern that the ruling would lead to further uncertainty amongst patients.

“Today’s decision leaves important health insurance protections shrouded in uncertainty despite overwhelming public support for these policies,” says AMA President Patrice A. Harris, MD, in a news release.

Gary LeRoy, MD, president of AAFP, says in a statement that the appeals court’s decision to return the case to the district court, “prolongs the uncertainty that millions of Americans face about whether they will have access to health care.”

In his statement, ACP President Robert McLean, MD, says his organization will continue the fight to ensure Americans don’t lose their healthcare coverage.

“We remain hopeful that the courts will agree that these provisions are constitutional and must remain in effect,” he says. “It is anticipated that the Supreme Court will ultimately decide whether the ACA’s coverage requirements and other patient protections will be upheld but that decision may be many months, even years, away.”

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