WASHINGTON, D.C. - The U.S. Court of Appeals for the Fifth Circuit on Wednesday struck down a central provision of the Affordable Care Act (ACA), ruling that the ACA’s individual mandate, which requires individuals to have health insurance coverage, is unconstitutional. In doing so, the court ignores the landmark ruling by the Supreme Court in 2012 which upheld the individual mandate. Instead, the Fifth Circuit sent the case back to a federal district judge in Texas to re-examine whether the ACA can continue without the key provision of the individual mandate. This judge in 2018 deemed the entire ACA unconstitutional. The Fifth Circuit has asked the lower court to provide a more in-depth analysis of its 2018 decision (described in this NASW Practice Alert).
Angelo McClain, chief executive officer of the National Association of Social Workers (NASW) said, “NASW is deeply disappointed in the appellate court’s decision, which creates uncertainty for millions of Americans and puts the ACA, consumer protections and Medicaid expansion at risk at a time when health care costs continue to skyrocket.” Over 17 million Americans could lose health insurance coverage if the ACA is thrown out. More than 50 million people with pre-existing medical conditions could be denied insurance, and insurers would no longer have to cover people up to age 26 on their parents’ plans. And until a decision is made, which could be well after the 2020 elections, insurers may back out of ACA’s programs or make other adjustments due to their lack of confidence in the survivability of the law.
The reason the court was able to revisit the Supreme Court ruling is the Republican-controlled Congress in 2017, in an unsuccessful effort to repeal the ACA, revised the law to eliminate the financial penalty for those who did not purchase individual insurance. Attorneys general from a number of states argued that the zero penalty introduced an unconstitutional legal obligation or mandate to purchase insurance. Further, they argued that individual mandate was the cornerstone of the ACA, and if it was invalid, so was the entire law. On this basis, they were able to launch a new challenge to the ACA. This is a flawed argument on numerous legal grounds which the appellate court should have soundly rejected.
Instead, Judge Reed O’Connor of the Federal District Court in Fort Worth in 2018 accepted this argument and struck down the entire ACA as invalid. Judge Reed will now review Wednesday’s Fifth Circuit court decision and has already signaled that he will come to the same conclusion.
California Attorney General Xavier Becerra plans to ask the Supreme Court to hear the case. He led 21 states that intervened in the appellate court case and argued to save the ACA. Supreme Court is unlikely in the near term, as it will likely wait for the district court to rule. It will likely be months, and perhaps years, before there is a final legal decision on the ACA that would affect consumers.
As this case continues to make its way through the courts, the ACA remains the law. There is no immediate effect on coverage or protections for consumers, and individuals should continue to maintain health insurance coverage for 2020.
NASW will continue to closely follow developments in any challenges to the ACA and work in coalition with partner organizations to advocate for health insurance coverage and health care access for social workers and consumers.