Affordable Care Act Court Challenge

A federal judge in Texas struck down the entire ACA on Friday, but the law will stay in place pending appeals. NPR's Michel Martin talks with Julie Rovner of Kaiser Health News about the implications.

MICHEL MARTIN, HOST:

We're going to start the program today with the latest news about the Obama administration's signature legislative accomplishment - the Affordable Care Act. In most states, you have a few more hours until midnight tonight to sign up for health insurance under the law. But the future of the law is in peril again because a federal judge in Texas yesterday ruled the entire law unconstitutional. U.S. District Judge Reed O'Connor says that's because Congress last year eliminated the tax penalty for being uninsured, and he said that meant the law can't be sustained as an extension of Congress's taxing power.

As you might imagine, many legal analysts are debating the judge's legal reasoning. But we're going to focus on what this means for people who've been getting health insurance through the law, so we called Julie Rovner for that. She is chief Washington correspondent for Kaiser Health News.

Welcome back, Julie. Thanks so much for joining us.

JULIE ROVNER: Thanks for having me.

MARTIN: So how does this affect people who are signing up now? Will they still be able to get insurance in 2019?

ROVNER: Yes. Nothing changes for the moment. Even the Trump administration has said that it will wait until all of the appeals are exhausted, the legal process is finished. So if you're going to - if you need to sign up for health insurance, you should. If you're in one of the several states where it's extended - that where you can sign up through January - you can - you have time to do that, too. Nothing else about the law will change immediately as a result of this ruling.

MARTIN: Now, this law has been upheld twice already by the United States Supreme Court. So why is there another legal question about whether it's constitutional?

ROVNER: Well, because Congress made a change last year in the tax bill. It zeroed out the penalty for - the tax penalty for people who didn't have insurance. And what the 18 Republican attorneys general argued in their brief is that without that tax penalty - that was what the Supreme Court said that the law could hang on back in 2012 - without it, the whole rest of the law has to go away. The Trump administration said maybe not that much. They argued that just the preexisting condition protection should go away. But the judge agreed with the original claim in the lawsuit that said the whole law has to go down.

MARTIN: So will this case definitely get to the Supreme Court?

ROVNER: I think most people think it will probably get to the Supreme Court. There is some thought that the 5th Circuit, which is where this case is - it's a pretty conservative circuit. But even they might not - not only not agree with this judge's take on it but might not agree that the plaintiffs in the case even have standing to sue. So it could get rejected, basically, on a technicality. But there is probably a good chance that it will eventually get to the Supreme Court.

MARTIN: So here's where I'm asking you to speculate, but what would happen if this ruling is eventually upheld - if the court, for whatever reason, decides that this judge is right, and this case, which was brought by all these Republican attorneys general, does have merit? What happens?

ROVNER: Well, it's not even really speculation. The Affordable Care Act is an enormous law. It's not just what we think of as the people signing up on the insurance exchanges and getting protections for preexisting conditions. It was the big expansion of Medicaid. It was a number of new benefits and huge payment changes for Medicare. It renewed the Indian Health Service. It allowed for generic biologic drugs. All of those things would go away if the entire law was struck down.

And a lot of analysts say it would really plunge the nation's health care system into chaos. The federal government wouldn't know - wouldn't be able to basically pay for Medicare because all of the Medicare payments have now been structured because of the Affordable Care Act. So if it went away, it would be really an enormous disruption.

MARTIN: So we have about a half a minute left. Do you have any sense of what the timing of all this might be? I can imagine that this is very nerve-wracking for people who are getting their health insurance because of this or - you just don't follow this stuff every day.

ROVNER: It is. Well, we've been waiting two months - more than two months just for this decision, so it's not clear how long it will take. But one thing that this does is it throws the Affordable Care Act into uncertainty again. Every time it seems that it stopped and this is what we're going to have, something else changes. So, as long as this takes, we're going to have this uncertainty with the law.

MARTIN: That is Julie Rovner. She's the chief Washington correspondent for Kaiser Health News.

Julie, thank you so much.

ROVNER: You're so welcome.

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