Justice Department Shifts Policy, Says Entire Affordable Care Act Should Be Overturned

The Trump administration's shift in a major legal case against the Affordable Care Act could lead to the reversal of the expansive law and far-reaching effects on all Americans' health care.

AILSA CHANG, HOST:

With just two sentences in a legal filing, the Justice Department shifted its policy towards the Affordable Care Act. Before, it had wanted to repeal only some parts of the law, including protections for people with pre-existing medical conditions. Now it says the entire law should be overturned. If that happened, the consequences would reach deep into the health care system and beyond.

NPR health policy correspondent Alison Kodjak is here to explain this all to us. Hey, Alison.

ALISON KODJAK, BYLINE: Hi, Ailsa.

CHANG: So can you just first explain the context here? Where did this legal filing happen?

KODJAK: Yeah, so this is all happening in relation to a legal case brought by a group of Republican attorneys general who wanted to overturn the law. And in December, a federal judge in Texas granted them their wish and ruled the entire Affordable Care Act was unconstitutional. So yesterday, in this very short filing, the Justice Department basically said, yes, we agree with that judge, and we want the entire law gone, too.

CHANG: I'm just sort of thinking here. Republicans had won control of the White House and Congress in 2016, promising to repeal the ACA. But then there was this shift where we saw a lot of Republican candidates promise during the 2018 midterm elections that they would preserve parts of the ACA. So this feels like another shift, doesn't it?

KODJAK: It is a bit of a shift. And you know, this is - what most people were opposed to in the ACA are those provisions in the law that required people to buy health insurance. People didn't like that. Last year - or in late 2017 - so the tax bill, Republicans essentially succeeded in getting rid of that part of the law. So what happened in Texas is that the judge there ruled that without that part of the law, the entire 2,000 pages of the ACA fall apart, even the parts that people like.

A lot of legal scholars say the legal reasoning behind that ruling is weak at best and is mostly politically driven. I talked earlier today to former Attorney General Eric Holder, and he said that the Justice Department's action backing that ruling is, quote, "distressing and alarming." And here's what else he said.

ERIC HOLDER: To see the Justice Department signing up to support that decision shows how ideologically-driven the department has become.

CHANG: Now, this latest move by the Justice Department - it won't have any immediate effect on people's health care, right?

KODJAK: No. This case is still in the courts, and this doesn't change that. Until it gets resolved, the law stands. And right now, there are more than 10 million people with insurance just through the ACA's Medicaid expansion. And then there's almost 12 million more who have private insurance through the ACA exchanges. Those insurance policies won't change now. But if this ruling by the judge in Texas stands, then health care coverage for all those people could end up being in jeopardy.

CHANG: Now, you've said before on our air that the ACA is more than just health insurance. What else might change if the whole law is overturned?

KODJAK: Yeah. I mean, it is. It's 2,000 pages. And when it was written, they were trying to basically both expand insurance coverage but also cut costs, improve health. So the ACA has provisions that determine how and how much hospitals, doctors, nursing homes, physical therapists and everyone else get paid. All that would disappear and have to be reorganized. The ACA also defines what health care services are free to consumers, like mammograms or colonoscopies. And it does other things like requires restaurants to include nutrition information on their menus.

CHANG: That's NPR's Alison Kodjak. Thank you, Alison.

KODJAK: Thanks, Ailsa.

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