On Wednesday, December 18, the U.S. Fifth Circuit Court of Appeals in New Orleans struck down part of the Affordable Care Act provision, ruling that the requirement that people have health insurance was unconstitutional on a 2-1 decision and sent the case back to the lower court in Texas for further analysis. Several state attorneys general filed the original lawsuit attempting to bring down the entire ACA because Congress repealed the tax that enforces the individual mandate to buy insurance.

The Administration attempts to overturn the Affordable Care Act or Obamacare has included several attempts by the Republicans in eliminating parts of the ACA. They managed to do away with the individual mandate by eliminating the tax penalty that enforces the requirement to have insurance. The Republican argument is that the Supreme Court ruling upholding the ACA in 2012 was based in part on that tax and mandate.

Repealing the ACA would cause tens of millions of people to lose health insurance including young adults now covered under their parent’s plans, allowing insurance policies to limit or deny coverage if a customer has preexisting health conditions, and dismantling of Medicaid expansion that covers low income families and single adults.

Judge Reed O’Connor of the Federal District Court in Fort Worth ruled that “the keystone” of the law was the individual mandate and that it could not be severed from the entire ACA. That would mean that the entire law would be thrown out. With Congress eliminating the individual mandate penalty, the 5th Circuit Court punted on the question on whether the ACA in its entirety was unconstitutional, the decision was sent back to Judge O’Connor.

Since December developments include: on January 6, the Supreme Court ordered the state of Texas, the federal government, and others challenging the ACA to respond to motions filed late last week by 20 states led by California and the House of Representatives seeking expedited review of a December federal appeals court ruling that puts the fate of the healthcare program in jeopardy. The respondents have until Jan. 10 to explain why they oppose the requests for swift review and resolution.

The final numbers for this year’s enrollment on the national exchange showed that approximately 8.3 million signed up for coverage. The numbers will not be final for a few more weeks but the initial results are off slightly from last year with approximately 200,000 fewer sign ups. The numbers do not include the 13 states that run their own exchange website including the states of California and New York.

Finally new research published in the Journal of Health Affairs provided evidence that in southern states that took the Medicaid expansion option under the ACA were demonstrating better health outcomes for nonelderly adults. The findings bolster the argument for expanding access to health care and Medicaid for the 14 states that are still rejecting the Medicaid expansion despite the fact that the federal government picks up 90 percent of the cost.

John Graves, the lead author of the study, Vanderbilt University School of Medicine, said “Health care policy experts and physicians have suspected this for a while, but with our study, we now have the actual evidence showing that non-expanding Southern states could materially improve population health if they accept expansion funds.”

About the Author:

John Sciamanna is CWLA's Vice President of Public Policy.

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