December 17, 2018

What's next now that federal judge rules ACA is unconstitutional?

Courtesy / Office of U.S. Sen. Susan Collins
Courtesy / Office of U.S. Sen. Susan Collins
U.S. Sen. Susan Collins, R-Maine, appearing on ABC's “This Week” Sunday with host George Stephanopoulos, said she believes that the federal judge's ruling on the Affordable Care Act will be overturned.

Friday's ruling by a federal judge in Texas that the Affordable Care Act is unconstitutional plunged President Obama's landmark health care law into uncertainty once again.

Modern Healthcare reported that U.S. District Judge Reed O'Connor said the entire law was invalidated by the Republican-led 2017 Tax Cuts and Jobs Act approved last December, which zeroed out the individual mandate penalty.

O'Connor agreed with the legal arguments put forward by 20 Republican state attorneys general and governors (including Maine Gov. Paul LePage) as well as two individuals challenging the constitutionality of the individual mandate, now that the penalty for failing to have health insurance will be $0 beginning in 2019. The GOP plaintiffs argued that the individual mandate cannot be severed from the rest of the ACA and if that mandate falls, the rest of the law was thereby invalid, according to a September blog in HealthAffairs.

In the short term, the judge's ruling in the Texas lawsuit won't change anything — especially since the Trump administration pledged over the weekend to continue enforcing the ACA, Modern HealthCare reported Sunday.

An appeal is already in the works, Modern HealthCare reported, with a coalition of 17 Democratic attorneys general planning to defend the ACA with an appeal to the Fifth Circuit Court of Appeals. They've asked for an immediate stay of O'Connor's ruling.

In Maine, 75,809 people signed up for coverage this year via Maine's exchange, down about 4.5% from the 79,407 people who enrolled in plans for 2017, according to That, in turn, was a decrease of about 5.5% from the 84,059 who enrolled the year before. Figures for 2019 aren't yet known, since the open enrollment period just ended on Dec. 15.

Collins: Ruling will be overturned

Appearing on ABC's "This Week" Sunday with host George Stephanopoulos, U.S. Sen. Susan Collins, R-Maine, said she believes that the judge's ruling will be overturned.

"The judge's ruling was far too sweeping," Collins told Stephanopoulos, according to the transcript sent by her office to Mainebiz. "He could have taken a much more surgical approach and just struck down the individual mandate and kept the rest of the law intact. I believe that it will be overturned."

Noting that the federal judge in Texas based his ruling on the GOP-sponsored tax bill, which brought the tax penalty for violating the individual mandate down to zero, Stephanopoulos asked Collins if she had any second thoughts on her vote supporting the tax bill.

"Not at all," she said. "I think it's important to keep in mind what the impact of the individual mandate was. Eighty percent of those who paid the penalty under the individual mandate earned less than $50,000 a year. So this disproportionately affected lower- and middle-income families. In addition, not one Democratic senator offered an amendment to strike the repeal of the individual mandate, although they had the opportunity to do so.

"And that's because it was probably the most unpopular and unfair provision of the Affordable Care Act. There are many good provisions of the law. Those should be retained."

Collins told Stephanopoulos she thought the ACA could be saved legislatively if Democrats and Republicans could work in a bipartisan way to address affordability problems in the ACA's individual marketplace.

"Actually, we did bring a bill to the floor that would have reduced premiums in the individual marketplace by as much as 40% over the [next] two years," she said. "That came to the floor in early March and regrettably was blocked, much to my surprise, by a member of the Democratic leadership. It's something we should still pursue because affordability is a real problem for so many Americans who do not receive the subsidies under the Affordable Care Act because they make just a little bit more than 400% of the poverty rate."

Pingree vows to fight partisan ruling

U.S. Rep. Chellie Pingree, D-Maine District 1, characterized Friday's ruling as the latest example of Republican efforts to kill the ACA.

"Republicans have attempted to repeal the ACA in Congress dozens of times," she said in a statement sent to Mainebiz. "As they've been unsuccessful in ripping health care from millions through the legislative process, they've turned to the courts to accomplish their goal. This absurd ruling will be appealed, and in the meantime, I want to reassure Mainers relying on the ACA's protections that their 2019 health insurance plans will proceed as expected. The midterm elections were an overwhelming affirmation that Americans want affordable health care and the incoming Democratic House will do everything in our power to ensure affordable health care for all."

The American Medical Association criticized the ruling, stating that it would be joining other stakeholders in an appeal.

"Today's decision is an unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections and other policies that have extended health insurance coverage to millions of Americans," said Dr. Barbara L. McAneny, president of the American Medical Association. "It will destabilize health insurance coverage by rolling back federal policy to 2009. No one wants to go back to the days of 20% of the population uninsured and fewer patient protections, but this decision will move us in that direction."


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