Policy Archive

ACA unconstitutional? What does this mean for preventive care and pre-existing conditions?

On December 14, 2018, a Texas district court judge ruled that the Affordable Care Act (ACA) is unconstitutional due to a recent change in federal tax law. As part of the 2017 tax reform package, the ACA was amended to eliminate the penalty for not having health insurance. A lawsuit argued, "Once the heart of the ACA—the individual mandate—is declared unconstitutional, the remainder of the ACA must also fall." The judge agreed.

The White House issued a statement, saying: "We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place." So, the ACA will not change for the time being. It is important to note that the Supreme Court previously upheld the ACA as constitutional in 2012 and 2015.

Although unlikely, if the new ruling is ultimately sustained it could cause widespread disruption across the U.S. health care system—from preventive services to Medicaid expansion, generic biologic drugs, and coverage for those with pre-existing conditions. Both parties acknowledge that dismantling the ACA without a replacement will have far-reaching implications so there is an incentive to find a bipartisan solution that addresses the key concerns of the American public.

For instance, under the ACA, insurers are not allowed to set premiums based on a person's health history. And the ban on excluding pre-existing conditions from coverage means that insurers cannot refuse to pay for treatments because of a policyholder's medical background.

The majority of Americans say that it is "very important" for the law to continue prohibiting health insurers from denying coverage because of medical histories and for insurers be barred from charging sick people more, according to the Kaiser Family Foundation's September tracking poll.

A number of prominent health organizations released statements on the ruling:

"The judge got it wrong," said Charles "Chip" Kahn, president of the Federation of American Hospitals. ...this ruling would have a devastating impact on the patients we serve and the nation's health care system as a whole... Having this decision come in the closing hours of open enrollment also sows seeds of unnecessary confusion."

"Today's decision is an unfortunate step backward for our health system that is contrary to overwhelming public sentiment," said Barbara McAneny, president of the American Medical Association. "No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections, but this decision will move us in that direction."

America's Health Insurance Plans, the industry's main trade group, called the opinion "misguided and wrong," and is trying to reassure consumers that their health coverage will remain "strong and stable" while the ruling is appealed.

The lawsuit has been opposed by a coalition of 17 state attorneys general, led by California's Xavier Becerra, a former congressman. California has already indicated that it will appeal. As such, the ACA will remain in place while the law's future is debated in the courts, a process that could take years to resolve. The final decision likely won't be made until the case reaches the Supreme Court again.

People who bought coverage on the health care exchanges shouldn't worry. They will be insured for the foreseeable future.