A federal judge threatened to throw the U.S. healthcare system into disarray last week when he declared the entire Affordable Care Act unconstitutional. But the nation’s health program, also known as Obamacare, isn’t going away anytime soon.
Last December, the Republican-controlled Congress effectively removed Obamacare’s “individual mandate,” or the tax lodged against people who didn’t carry government-regulated insurance plans. Soon after, Republican attorneys general sued the federal government, arguing that without that mandate, the entire law was unconstitutional.
On Friday, U.S. District Judge Reed O’Connor took their side and ruled the entire law should be scrapped, including the parts that allow wider government-funded care for poor people and ensure protections for people with pre-existing conditions.
President Donald Trump has already voiced his excitement on Twitter that the controversial decision might wind up in front of a newly right-leaning Supreme Court. But that wouldn’t happen until at least October — if at all.
For now, Obamacare is still in place. Open enrollment for 2019 plans ended on Saturday, and the judge’s decision doesn’t affect those plans. Here’s what we know so far:
What’s at stake?
The Affordable Care Act, also known as Obamacare, currently protects people with pre-existing conditions, who were often denied affordable insurance before. The 2010 law also made certain types of medical care, like flu shots and cancer screenings, free by declaring them “preventive.”
The Affordable Care Act also ensured coverage of so-called “essential benefits,” like pregnancy care, prescription drugs, mental health care, and more. Further, Obamacare made Medicaid expansion, a program that allows for greater access to low-cost health insurance for poor people, possible.
As a result, the law drastically reduced the number of people who were uninsured.
What does the ruling say?
“The court finds the Individual Mandate essential to and inseverable from the other provisions of the ACA [Affordable Care Act],” O’Connor wrote in his ruling on Friday. In other words, since the individual mandate is gone, the entire law has to go, too.
That’s exactly what the Republican attorneys general who brought the case had argued.
In the Supreme Court’s 2012 ruling in National Federation of Independent Business v. Sebelius, which also sought to take down key provisions of the health care law, Chief Justice John Roberts held that the Affordable Care Act and the individual mandate were constitutional because Congress has the right to make and collect new taxes. Based on that logic, Republicans thought that if the tax itself didn’t exist, then the entire law shouldn’t exist.
So they took away the tax last December and sued to take down the Affordable Care Act in February. The Trump administration’s Justice Department then made the unusual decision not to defend federal law.
With the Justice Department essentially shrugging off its duties, some Democratic attorneys general and political officials stepped in to back up Obamacare in court.
What happens next?
Democrats, led by California’s attorney general, will likely appeal the judge’s ruling, and an extended court case could take months or years to reach a conclusion.
In all likelihood, the case will wind up before the Supreme Court, although the justices wouldn’t take it up until next October. Legal experts have noted, however, the case could also be overturned before it reaches the high court. Obamacare already went before the high court twice and was upheld both times.
The difference now, of course, is the court has a solidly conservative majority with the confirmation of justices Brett Kavanaugh and Neil Gorsuch, both of whom have previously sided with challenges to the Affordable Care Act.
What does this mean politically?
Democrats, who won control of the House back in the midterms, ran on protecting the Affordable Care Act and its popular pre-existing provision. Voters repeatedly said health care was among their most important issues when picking a favored candidates.
That means Friday’s ruling might not bode well for Republicans, especially if there’s not an easy conclusion before the presidential election in 2020 — or if insurers, sensing risk in the marketplace, raise monthly premiums back up to a level that average people can’t afford.
Trump wrote on Twitter Monday that Republicans would be willing to work on a bipartisan health care solution with Democrats if Obamacare were struck down, but that hasn’t exactly worked out in the past.
Cover image: President Donald Trump gives thumbs up as he steps off Air Force One as he arrives Monday, Oct. 8, 2018, at Andrews Air Force Base, Md. (AP Photo/Alex Brandon)