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| Appeals court rules ACA’s individual mandate unconstitutional; lower court to decide whether rest of law can stand without it | Appeals court rules ACA’s individual mandate unconstitutional; lower court to decide whether rest of law can stand without it |
| (30 minutes later) | |
| A federal appeals court on Wednesday struck down part of the Affordable Care Act, ruling that its requirement that most Americans carry insurance is unconstitutional while sending back to a lower court the question of whether the rest of the law can stand without it. | A federal appeals court on Wednesday struck down part of the Affordable Care Act, ruling that its requirement that most Americans carry insurance is unconstitutional while sending back to a lower court the question of whether the rest of the law can stand without it. |
| The decision by a three-judge panel of the U.S. Court of Appeals for the 5th Circuit has little immediate practical effect because Congress already has removed the penalty for the insurance requirement. But the two-to-one ruling leaves the rest of the sprawling statute in limbo heading into the 2020 presidential and congressional elections in which health-care costs and insurance have emerged as pivotal issues. | |
| The panel’s one Democratic appointee dissented from the ruling, writing that the Republican states challenging the law did not have standing to do so. If they did, she wrote, she would find the mandate constitutional. | The panel’s one Democratic appointee dissented from the ruling, writing that the Republican states challenging the law did not have standing to do so. If they did, she wrote, she would find the mandate constitutional. |
| The decision carries significant political implications: It catapults to the forefront of the 2020 presidential and congressional campaigns questions about insurance coverage and consumer protections for people with preexisting medical conditions — issues that Democrats wielded in last year’s midterm elections to win a House majority . | The decision carries significant political implications: It catapults to the forefront of the 2020 presidential and congressional campaigns questions about insurance coverage and consumer protections for people with preexisting medical conditions — issues that Democrats wielded in last year’s midterm elections to win a House majority . |
| The 5th Circuit decision may or may not be the final word on the ACA, depending on whether its opinion is appealed to the Supreme Court and, if so, whether the high court takes the case. But by sending a thorny legal question back to the Texas jurist who already has held the law unconstitutional, the judges effectively slowed the case, so that the high court could not take it during its current term and decide it before the November elections. | |
| Wednesday’s ruling resembles the legal position the Trump administration staked out in the case a year ago before the Justice Department hardened its stance to argue in March thatthe whole law is unconstitutional. | Wednesday’s ruling resembles the legal position the Trump administration staked out in the case a year ago before the Justice Department hardened its stance to argue in March thatthe whole law is unconstitutional. |
| The ruling comes in a case initially regarded as marginal by ACA supporters and critics alike. But since last December, when a federal trial court judge held the whole law unconstitutional, it has posed a more serious challenge to the 2010 statute passed by a Democratic Congress and considered a major accomplishment of President Barack Obama’s first term. | The ruling comes in a case initially regarded as marginal by ACA supporters and critics alike. But since last December, when a federal trial court judge held the whole law unconstitutional, it has posed a more serious challenge to the 2010 statute passed by a Democratic Congress and considered a major accomplishment of President Barack Obama’s first term. |
| The lawsuit was filed in February, 2018 by Texas Attorney General Ken Paxton (R) and his counterparts from other Republican-led states — currently 18 in all. Their main argument is that the ACA became unconstitutional when Congress adopted a broad tax bill in late 2017 that, starting this year, eliminated the law’s penalty for people who flout the requirement that most Americans carry health insurance. The plaintiffs pointed out that when the Supreme Court upheld the ACA in 2012, the majority reasoned it was legal under Congress’s taxing powers. | |
| The two Republican-appointed judges on the 5th Circuit panel sided with this reasoning. Now that Americans are free to ignore the insurance requirement with no risk of penalty, the majority wrote, the “attributes that saved the statute because it could be read as a tax no longer exist.” Those jurists are Judges Kurt Engelhardt appointed by President Trump last year and Jennifer Walker Elrod, an appointee of President George W. Bush. | |
| The suit further argues that sections of the law cannot be separated — or severed, in legal parlance — so that if the part of the law that includes the insurance requirement is no longer valid, then the entire law must be considered unconstitutional. | The suit further argues that sections of the law cannot be separated — or severed, in legal parlance — so that if the part of the law that includes the insurance requirement is no longer valid, then the entire law must be considered unconstitutional. |
| In June of 2018, the Trump administration decided not to defend the law in court. It was an unorthodox step, since the federal government is the defendant in the case, and the executive branch typically defends existing statutes in court. | In June of 2018, the Trump administration decided not to defend the law in court. It was an unorthodox step, since the federal government is the defendant in the case, and the executive branch typically defends existing statutes in court. |
| At first, the Justice Department did not go as far as the GOP attorneys general, contending the insurance requirement and consumer insurance protections should be struck down, while saying the rest of the law could be preserved. However, the administration changed positions early this spring, agreeing with Paxton and the others that the whole law is unconstitutional. | At first, the Justice Department did not go as far as the GOP attorneys general, contending the insurance requirement and consumer insurance protections should be struck down, while saying the rest of the law could be preserved. However, the administration changed positions early this spring, agreeing with Paxton and the others that the whole law is unconstitutional. |
| The law has been defended mainly by a coalition of Democratic attorneys general, led by California’s Xavier Becerra, who contend that, in changing tax law, Congress’s GOP majority lowered the ACA’s tax penalty to zero but did not eliminate it. Even if that aspect of the law were invalidated, Congress gave no hint in the tax law that it intended to disrupt the rest of the ACA, they contend. | The law has been defended mainly by a coalition of Democratic attorneys general, led by California’s Xavier Becerra, who contend that, in changing tax law, Congress’s GOP majority lowered the ACA’s tax penalty to zero but did not eliminate it. Even if that aspect of the law were invalidated, Congress gave no hint in the tax law that it intended to disrupt the rest of the ACA, they contend. |
| The opinion follows by five months oral arguments in the case in early July. During the more than 90-minute hearing in a circuit courtroom in downtown New Orleans, the panel’s two Republican appointees, Engelhardt and Elrod, expressed skepticism to varying degrees that the ACA should remain intact. | |
| The panel’s lone Democratic appointee, Judge Carolyn Dineen King, a former chief judge of the court who was appointed by President Jimmy Carter, said nothing during the hearing. | |
| The three judges were hearing an appeal of the opinion issued by U.S. District Judge Reed O’Connor issued in mid-December, on the eve of the deadline for the annual sign-up period for Americans to buy health plans through the ACA’s online marketplaces. The 5th Circuit ruling comes weeks before the Nov. 1 start of the enrollment period for 2020 ACA health plans. | The three judges were hearing an appeal of the opinion issued by U.S. District Judge Reed O’Connor issued in mid-December, on the eve of the deadline for the annual sign-up period for Americans to buy health plans through the ACA’s online marketplaces. The 5th Circuit ruling comes weeks before the Nov. 1 start of the enrollment period for 2020 ACA health plans. |
| A Bush appointee, O’Connor is a conservative judge on the U.S. District Court for the Northern District of Texas. | A Bush appointee, O’Connor is a conservative judge on the U.S. District Court for the Northern District of Texas. |
| In the 55-page opinion, O’Connor wrote that the law’s individual mandate is unconstitutional because it “can no longer be fairly read as an exercise of Congress’ tax power.” That requirement, he wrote, “is essential to and inseverable from the remainder of the ACA.” | In the 55-page opinion, O’Connor wrote that the law’s individual mandate is unconstitutional because it “can no longer be fairly read as an exercise of Congress’ tax power.” That requirement, he wrote, “is essential to and inseverable from the remainder of the ACA.” |
| Despite Trump’s frequent condemnation of the ACA, his administration told the court it was willing to keep the law in place while the case was appealed. O’Connor stayed his decision to let that happen. | Despite Trump’s frequent condemnation of the ACA, his administration told the court it was willing to keep the law in place while the case was appealed. O’Connor stayed his decision to let that happen. |
| If the appellate decision is upheld, the most popular element that would come unglued is insurance protections for Americans with preexisting medical conditions. Congressional Democrats immediately seized on that uncertainty. “Trump asked the courts to take away pre-existing condition protections for Americans, and after today’s decision, millions of families will go to sleep scared that those protections are still at risk,” Sen. Ron Wyden (Ore.), the Senate Finance Committee’s ranking Democrat, said in a statement. | |
| Republicans cheered the ruling. “I applaud the Fifth Circuit’s decision,” Paxton, the Texas attorney general, said in a statement. “As the court’s opinion recognized, the only reason the Supreme Court upheld Obamacare in 2012 was Congress’ taxing power, and without the individual mandate’s penalty that justification crumbled.” | |
| Other elements of the law that are at potential risk include insurance subsidies for most people buying health plans through ACA marketplaces, designed for individuals and families that cannot get affordable health benefits through a job; the expansion of Medicaid in three dozen states, the ability of young adults to stay on their parents’ insurance policies until they turn 26; and no-charge preventive care for older Americans on Medicare. | |
| The law also is woven more subtly into many other aspects of the health-care system, from payment formulas for hospitals and doctors, to experiments intended to nudge health-care from a system that pays for the quantity of medical services to one based on the value of care patients receive. | The law also is woven more subtly into many other aspects of the health-care system, from payment formulas for hospitals and doctors, to experiments intended to nudge health-care from a system that pays for the quantity of medical services to one based on the value of care patients receive. |
| One health agency created under the law is providing the underpinning for some of the Trump administration’s proposals to lower drug prices. | One health agency created under the law is providing the underpinning for some of the Trump administration’s proposals to lower drug prices. |
| Once considered a far-left idea, ‘public option’ insurance swerves into the mainstream | Once considered a far-left idea, ‘public option’ insurance swerves into the mainstream |
| Voters have big health-care worries, but not the ones Democrats are talking about | Voters have big health-care worries, but not the ones Democrats are talking about |
| Why Vermont’s single-payer effort failed and what Democrats can learn from it | Why Vermont’s single-payer effort failed and what Democrats can learn from it |