On Tuesday, July 9, 2019 the 5th Circuit’s U.S. Court of Appeals heard arguments to strike down the Affordable Care Act in its entirety. Twenty states, led by Republican governors and attorneys general, have been seeking the law’s elimination because Congress, with the tax cut package of last year, eliminated the mandatory tax on people who do not have health insurance coverage. That tax functioned as a mandate to buy insurance. The Trump Administration’s Justice Department will not defend the law and as a result 20 states (led by California) plus the District of Columbia are defending the law.
In December of 2018 Judge Reed O’Connor from the U.S. District Court of Northern Texas stuck down the entire ACA. (Judge O’Connor is the same Judge that ruled against the Indian Child Welfare Act (ICWA).

The U.S. Supreme Court in 2012 upheld the law but part of the rationale was around the tax penalty as an enforcement tool to make sure people are buying health insurance. The larger pool of insurance purchasers –especially when those purchasers are healthier and young—make insurance more affordable and makes the ACA protections, including the ban on insurance companies from denying health insurance (pre-existing conditions protections), workable, effective and less costly.

According to the Center for American Progress, an ACA repeal would, in the average congressional district, cause 45,600 people to lose their health insurance coverage. The Center for American Progress analysis looks at the district-by-district impact. It would hit hardest in congressional districts in states that expanded Medicaid, like California, Louisiana and Montana. But other populous states also would suffer a blow. As an example, they cite the 100,000 people who would lose coverage in Congresswoman Donna Shalala (D-FL) district.

If the Appeals Court decides to strike down the ACA or alter it significantly than it will likely find its ways way to the Supreme Court. Senate Majority Leader Mitch McConnell (R-KY) has said the Senate would act to prohibit insurance companies from denying coverage to people with an existing health condition. That action however without other ways to expand the number of healthy people buying health insurance could mean that people with these “pre-existing health conditions” could still buy insurance but the cost of those policies could be so costly, the protection would be rendered useless.