What A Ruling In Texas v. United States Could Mean For Health Care

Kaiser Health News reporter Julie Rovner speaks with NPR's Ari Shapiro about what was at stake during the faceoff between state Republican and Democratic attorney generals over the Affordable Care Act in a Texas courtroom.

ARI SHAPIRO, HOST:

To talk more about what this lawsuit could mean for health care, we turn to Julie Rovner, chief Washington correspondent for Kaiser Health News. Good to see you, Julie.

JULIE ROVNER: Nice to see you, Ari.

SHAPIRO: So what would happen if these Republican state attorneys general win and convince the judge to strike down the Affordable Care Act?

ROVNER: Well, there are two possible outcomes that would be termed a win for Republicans. One is that the judge would strike down the entire ACA. And people think about that as just the people who buy their own insurance, but the Affordable Care Act was an enormous law. It made big changes to Medicare, to Medicaid, to people with employer insurance. So actually blocking the entire law would be a huge change for the health care system. Now, what the Trump administration is arguing is that maybe the whole law isn't now unconstitutional, but the two pieces of the law that went directly to that tax penalty, which protect people with pre-existing conditions, maybe those should be struck down. Even that could have a major impact, although obviously not as major as taking the entire law down.

SHAPIRO: Now, a group of Republican senators put forward a bill to protect people with pre-existing conditions. So if the court does strike down protection for people with pre-existing conditions, does that somehow make up for it?

ROVNER: Well, they said that they hoped that it would. But it turns out that the bill that was introduced in the Senate requires insurers to cover people with pre-existing conditions, but it doesn't require them to cover that pre-existing condition. We saw this a lot prior to the Affordable Care Act where people in high-risk pools would go there because they had an illness. And they would get insurance, but the insurance didn't cover that illness. That's basically what this Republican bill would do.

SHAPIRO: Of course there's also the possibility that the court throws out the lawsuit, and nothing happens at all.

ROVNER: That's right, and that's what the Democrats are arguing. And in fact, there are a number of legal experts who have looked at this case, including some lawyers who helped push previous efforts to take down the Affordable Care Act in court. Even they say that this lawsuit is based on a fairly shaky premise. Despite that, however, this judge appeared to be somewhat sympathetic to their arguments.

SHAPIRO: Politically, do you think this could play into the midterm elections?

ROVNER: It is already playing into the midterm elections.

SHAPIRO: (Laughter).

ROVNER: It is pretty clear. This bill was - this lawsuit was filed back in February. A couple of these attorneys general are actually running for Senate seats in some of the swing states, in West Virginia and Missouri. They basically said at the time they want to fire up the conservative base, who is very disappointed that Congress did not repeal the entire Affordable Care Act. So this is a way they can say, look, we're still working on it. We're still trying to take it down. Democrats see this as a gift because the pre-existing condition protections are by far the most popular part of this law. That's why you saw the Republicans in the Senate scurrying to try to say, really, we'll take care of that part. So the Democrats are already running on it, too. You've seen lots of ads, so this is definitely as much political as it is legal.

SHAPIRO: Julie, you covered the debate to pass this law almost a decade ago. You covered the Supreme Court litigation surrounding this law several years ago.

ROVNER: Twice...

SHAPIRO: Is it unusual for a law this significant to be undergoing such major challenges to its very existence this long after it passed?

ROVNER: I think mostly what was significant about this law is that it was so partisan when it passed. I mean, nobody expected this many court challenges. It survived them so far. We'll see whether it survives this one.

SHAPIRO: That's Julie Rovner, chief Washington correspondent for Kaiser Health News. Thanks for coming into the studio today.

ROVNER: Thanks for having me.

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