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Why invalidating the ACA could cause ‘enormous disruption’ to American health care

The day before this year's deadline to sign up for health insurance under the Affordable Care Act, a judge in Texas ruled the law unconstitutional. As the case makes its way through the appeals process, Amna Nawaz sits down with Julie Rovner of Kaiser Health News to discuss who's involved in the legal challenge and the "enormous disruption" that would result from invalidation of the law.

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  • Judy Woodruff:

    The debate and the battles over the federal health care law titled the Affordable Care Act, but often referred to as Obamacare, have been a constant since it was enacted eight years ago.

    But, this weekend, a new round was fired in the battle that threatens the very future of the law itself. A federal judge in Texas ruled Friday night that the entire law is unconstitutional.

    And, as Amna Nawaz explains, by doing so, the judge has triggered a flood of questions about what happens now.

  • Amna Nawaz:

    Judy, U.S. District Judge Reed O'Connor sided with Republicans from 20 states who brought suit against the ACA.

    The judge said that, since Congress originally passed the law with the mandate to buy insurance, the law is unconstitutional without it. The decision will be appealed by other states and congressional Democrats.

    But it cast doubt on the future of the insurance markets that millions use. And the stakes go even higher. There are huge parts of the health care system, including Medicare, Medicaid, as well as payments to doctors, hospitals, and insurers, that are all intricately woven into the health care law.

    Julie Rovner of Kaiser Health News, who joined us Friday night about the insurance markets just before this broke, is back with us now.

    Welcome back.

  • Julie Rovner:

    Thanks for having me.

  • Amna Nawaz:

    So, before we tackle all the potential changes, let's just make clear what this means right now.

    Has anything changed immediately as a result of this ruling?

  • Julie Rovner:

    No, nothing has changed immediately.

    The Trump administration put out a statement Friday night and another statement today that said, while this case makes its way through the courts, we will continue to enforce the law as it is written.

    The president, however, has made it clear that he agrees with this decision and he has believed that the law is unconstitutional. So I suppose there's room for them to change their minds. But, at the moment, what the Department of Health and Human Services is saying is that everything goes as it has, until some conclusion to this.

  • Amna Nawaz:

    OK. So, at the moment, the law stands.

    But if the ruling is upheld, you have said the potential impact is enormous. There could be enormous disruption. What did you mean by that?

  • Julie Rovner:

    It is.

    Well, partly, it's because this law is so much larger than just the parts that we talk about all the time, the insurance markets and the people who buy their own insurance, and sometimes the Medicaid expansion. But this law made huge changes to the Medicare program, to how pretty much every provider under Medicare is paid. It did things like allowed generic versions of complicated biologic drugs.

    It renewed and change the Indian Health Service. There were enormous grants to help train health professionals. There was a lot of money for community health centers. All of that would go away if the entire law was actually struck down. That is so embedded now into the health care system, that it really would cause an enormous, enormous disruption.

    Almost hard to overstate how much of a disruption it would be.

  • Amna Nawaz:

    One of the more popular parts of the law, right, protection for people with preexisting conditions, those go away too?

  • Julie Rovner:

    Those — not only would those go away, but there were previous protections for people with preexisting conditions in employer-sponsored health plans that date back to 1996.

    And I actually discovered, doing another story earlier this fall, that those were written into the Affordable Care Act. So, if the Affordable Care Act preexisting condition protections for individuals went away, so would the ones for people in employment insurance, so…

  • Amna Nawaz:

    Something we talk about a lot too, people under the age of 26 allowed to stay on their parents' insurance. I just want to be clear about this. That also would go away if the ruling is upheld.

  • Julie Rovner:

    The requirement would go away. Presumably, employers could continue to allow it if they wanted to. But the requirement that employers offer it to parents of children up to age 26 would go away.

  • Amna Nawaz:

    You mentioned drug pricing. That has been a key part of this administration's agency priority at HHS there, Health and Human Services.

    What would this ruling — if it's upheld, what would it do to their ability to try to lower some of those drug prices?

  • Julie Rovner:

    Well, it would completely undercut a lot of what the administration is trying to do on drug prices, because most of the authority the administration is using is authority that Congress granted them in the Affordable Care Act.

    This is getting to be a refrain.


  • Julie Rovner:

    A lot of the things that the administration is trying to do are with the — what was allowed under that law. So it would really make it very difficult for a lot of the — a lot of Republican efforts.

    It's important to remember that, even though this law passed with only Democratic votes, the Democrats wrote it trying to appeal to Republicans. And, indeed, there are parts of it that Republicans like a lot.

  • Amna Nawaz:

    It's impossible to take the politics out of this. This was an effort led by Republican state attorneys general and Republican governors.

    Is there a countereffort now by Democrats to try to preserve the law?

  • Julie Rovner:

    Yes, actually, that's who's defending the law in court are Democratic attorneys general, because the Trump administration decided not to defend the lawsuit.

    They said, maybe the whole law shouldn't go down, but we think that perhaps the preexisting condition protections, things that were so intricately tied to that mandate, that maybe those should be struck down.

    So the Democratic attorneys general said, we would like to come in and defend the entire law. And the judge said OK. So it's basically right now Republican attorneys general vs. Democratic attorneys general.

  • Amna Nawaz:

    So there are a lot of ifs built into this conversation.

    If the ruling is upheld, right, the next place it could go is an appeals court. There's also the potential that it ends up before the Supreme Court. They have weighed in on the Affordable Care Act before. Do we know what would happen if it ends up before this court?

  • Julie Rovner:

    We don't really know, but it's been to the Supreme Court twice, and it's been upheld twice.

    And even people who were on the side of striking the law down or parts of it down before say that this particular case is pretty weak. So there is kind of an expectation that, if it got to the Supreme Court, that the Supreme Court would overturn it.

    However, we don't know how long that might take, and there might be a different Supreme Court by the time the law were to get there.

  • Amna Nawaz:

    We have no idea what's ahead, but you will be tracking it all for us.

    Julie Rovner, very, very good to see you again.

  • Julie Rovner:

    Nice to be here.

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