One year ago, in a deeply flawed ruling, a Texas judge found the portion of the Affordable Care Act (ACA) requiring most people to have coverage—known as the individual mandate—to be unconstitutional and declared that because of this finding, the entire law must be eliminated. This week, an appeals court agreed with the judge that the individual mandate is unconstitutional but declined to say how much of the law should fall with it, instead sending the case back to the lower court to reconsider that question.
What happens next is uncertain. The coalition of states defending the ACA already announced plans to appeal yesterday’s ruling directly to the Supreme Court, but the justices typically prefer to let the lower court process play out before getting involved. If the Supreme Court does choose to hear the case, a decision could come during an election year, likely further politicizing the health care law that has become a lifeline for many. If the Supreme Court decides to wait until the lower court rules, it could be several more years before a resolution is reached.
If the ACA is struck down, the effects on Americans’ health care coverage would be immediate and catastrophic. This includes older adults and people with disabilities, as several key provisions in the ACA have a direct impact on Medicare such as closing the prescription drug donut hole, the addition of preventive services, increased revenues for the Medicare Trust Fund, and much more.
The loss of the ACA would also end the Medicaid expansion that has improved coverage, access to care, and economic outcomes for low-income adults, and would eliminate consumer protections in private insurance that prevent denial of coverage for pre-existing conditions. This could leave some or all of the estimated 133 million Americans under 65 with pre-existing conditions unable to find any coverage at all that they could afford that would help them cover their health care costs. It could also mean the return of lifetime caps on coverage and an “age tax” for older people seeking insurance.
For now, the ACA remains in place. However, the Trump Administration fully supports its elimination and has thrown the weight of the Justice Department behind striking down the law, without establishing any safeguards or back up plans for the millions of lives at risk.
At Medicare Rights, we continue to be troubled by the lower court’s decision and the Department of Justice’s failure to defend the law in court. We urge states and the Trump Administration to abandon efforts to undermine the ACA, and to instead work together to improve health care and coverage for all Americans.
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