I’ve written several times about the 5th Circuit Court of Appeals case, Texas v United States, wherein a group of Republican Attorneys General are seeking to have the Affordable Care Act overturned in its entirety. The court issued a new ruling on Dec. 19th that mostly, but not entirely, favors the Republicans’ position.
At issue in the case is the individual mandate in the original bill that required all adults to get health insurance or face a tax penalty for failing to do so. During the many Republican attempts to rescind the entire law in 2017, the one thing they did manage to get enough votes to do was to repeal the individual mandate. A ha, the Republicans said, when the law was challenged in 2010 and 2011, the Supreme Court ruled that the only reason the law was constitutional was that the individual mandate was enforced through a tax penalty, thus placing it within Congress’ authority to tax. Now that the tax penalty is gone, they argue, the entire law is rendered unconstitutional.
This gets into the issue of severability — can the individual mandate be severed from the bill and the bill remain constitutional? Or does the removal of that portion of the bill make the whole thing unconstitutional? Basically, the new 5th circuit ruling temporarily punts on that issue, remanding the case back to the district court for a specific ruling on that particular issue. Everyone assumes that it will eventually end up at the Supreme Court, where it will once again be all up to Chief Justice John Roberts, whose last minute change of heart saved the bill in the first place. The Urban Institute spells out what would result if the Republicans win the case:
If the Supreme Court finds that the entire ACA without the individual mandate penalties in place is unconstitutional (the argument made by the plaintiffs in the case), the Court would overturn a groundbreaking piece of national legislation that expanded health insurance coverage to millions of people across the nation. Nearly 20 million people would lose insurance coverage if the ACA were repealed, and federal spending on health care would shrink by $134.7 billion in 2019 dollars. Coverage losses of this magnitude would affect every state and many groups of people; in this brief we identify the states and people who would face the largest losses and include new estimates by city. Repeal of the ACA would also directly affect health care providers because coverage losses lead to lower spending on health care services. We estimate that total health care spending by the nonelderly population under ACA repeal would fall by $94.6 billion (5 percent) in 2019 dollars. In addition, greater numbers of uninsured people would seek more free or reduced-price care from providers. We estimate that the cost of uncompensated care sought by uninsured people would nearly double, climbing by about $50 billion in 2019.
And that’s not all the negative implications of that outcome. The explosion of uncompensated care would set off another wave of doctor and hospital bankruptcies, further limiting access to health care, especially in smaller, rural communities where it is most needed. Eliminating Obamacare would be a devastating blow to the entire healthcare industry and to Americans’ ability to access affordable care when it’s needed.