Oh, yeah...the entire ACA could still be struck down at any minute.
I haven't written about it in a few weeks, but the ruling from the 5th Circuit Court of Appeals could (and likely will) be released any day now, so it's a good thing that Abby Goodnough wrote this piece for the New York Times today:
How Pending Decision on Obamacare Could Upend 2020 Campaign
A federal appeals court’s ruling on the Affordable Care Act could be a huge headache for the president and take Democrats’ focus off Medicare for all.
A federal appeals court in New Orleans is preparing a ruling on the Affordable Care Act that could put the law’s future front and center in the presidential race, overwhelming the current Democratic debate over Medicare for all and reigniting the health care-driven worries that helped Democrats win back the House last year.
Three judges on the Fifth Circuit Court of Appeals are weighing whether to uphold a Texas judge’s ruling that the law’s requirement for most Americans to have health insurance is unconstitutional, and that the rest of the sprawling law cannot function without it. It is hard to imagine a thornier domestic issue for President Trump, whose administration not only refused to defend the law in the case filed by Texas and 19 other states but sided with the plaintiffs, asking the court to invalidate it.
The rest of the article goes on to describe the potential rulings (strike the entire law down; kill "only" key parts of it; send it back to the original judge again; overturn the original decision altogether; or something else), as well as the political implications. Making matters even worse (assuming they rule for the plaintiffs): The decision will almost certainly come out sometime between now and mid-December...either just before or right in the middle of the 2020 ACA Open Enrollment Period.
One thing that everyone seems to agree on is that however they end up ruling, the other side will almost certainly immediately appeal the decision up to the Supreme Court, which would presumably then drag the case out well into 2020. The political firestorm which this will create in the middle of a Presidential election season can't be understated.
As a refresher, here's just some of what's at stake if the ACA is ultimately struck down:
- Medicaid expansion for over 16 million people across 36 states and DC: GONE.
- ACA exchange subsidies for over 9 million people nationally: GONE.
- Basic Health Plan coverage for over 800,000 people in Minnesota and New York: GONE.
- Discrimination against coverage of 52–130 million* with pre-existing conditions: BACK.
- Charging women more for the same policy simply because they’re women? BACK.
- Charging older Americans 5 to 6 times as much as younger Americans? BACK.
- Requirement that policies cover at least 60 percent of medical expenses: GONE.
- Requirement that policies cover maternity care and mental health services: GONE.
- Adult children being allowed to remain on their parents plans until age 26: GONE.
- Annual and lifetime limits on healthcare coverage claims? BACK.
- Requirement that policies cover preventative services at no out-of-pocket cost? GONE.
- Tax credits to lower premiums for low- and moderate-income enrollees? GONE.
- Financial help to reduce deductibles and co-pays for low-income enrollees? GONE.
- A hard cap on out-of-pocket expenses? GONE.
- The Medicare Part D “donut hole” being closed by the ACA? REOPENED.
*Total number depends on whether you're talking about conditions which have historically prevented people from being offered coverage at all or those which triggered absurdly higher premiums in order to be covered.
Speaking of Medicare, it would be impacted by the ACA being repealed a lot more than "just" the donut hole reopening:
This brief explores the implications for Medicare and beneficiaries of repealing Medicare provisions in the ACA. The Congressional Budget Office (CBO) has estimated that full repeal of the ACA would increase Medicare spending by $802 billion from 2016 to 2025.1 Full repeal would increase spending primarily by restoring higher payments to health care providers and Medicare Advantage plans. The increase in Medicare spending would likely lead to higher Medicare premiums, deductibles, and cost sharing for beneficiaries, and accelerate the insolvency of the Medicare Part A trust fund. Policymakers will confront decisions about the Medicare provisions in the ACA in their efforts to repeal and replace the law.