Internists Say Court’s Decision on ACA Potentially Could Put Health Care for Millions at Risk

Statement attributable to:
Robert McLean, MD, MACP
President, American College of Physicians

Washington, DC (December 19, 2019) — The American College of Physicians (ACP) is greatly concerned that the decision of a federal appeals court that the individual mandate of the Affordable Care Act (ACA) is unconstitutional could place health care for millions at risk, should the courts rule that the coverage requirements and other provisions of the ACA also must be overturned because they can’t be “severed” from the mandate. The court sent back the “severability” question to a lower court. What’s at stake is  whether the ACA’s pre-existing condition protections, essential benefit requirements, funding for Medicaid expansion, and other provisions will be upheld or overturned, with the health and lives of the millions of patients being at risk depending on what the courts decide.

ACP has been involved in this case from the beginning. We joined in an amicus brief with the American Medical Association, American Academy of Family Physicians, American Academy of Pediatrics, and American Academy of Child and Adolescent Psychiatry, which urged the lower court and then the appeals court hearing this case to uphold the constitutionality of the ACA, emphasizing the grave impact on patients should the law be overturned. Our brief argues that, “Even if this Court concludes that . . .  that the minimum coverage provision [individual mandate] cannot be fairly interpreted as a lawful exercise of Congress’ taxing power, that provision is severable from the remainder of the ACA. Plaintiffs insist, however, that the entire ACA must be enjoined because the minimum coverage provision cannot be severed from the remainder of the ACA. That argument is meritless.”

We continue to believe this to be true and remain hopeful that the courts will agree that the coverage requirements and other protections afforded by the ACA are constitutional and must remain in effect.

This issue is not just an argument about the law and congressional intent. ACP will continue to emphasize, as we did in the amicus brief, the impact on the health and lives of millions of patients depending on what the courts decide. At  risk are the protections for those with pre-existing conditions, requirements that insurers cover a core set of essential medical services, funding for Medicaid expansion and the health insurance of all those who gained coverage under the program, and Medicare coverage of preventive services at no out-of-pocket cost for seniors. Also at risk is the ban on insurers imposing annual or lifetime limits on coverage.

ACP remains committed to ensuring that no patient loses coverage, pre-existing conditions protections, essential benefits, or any of the other essential coverage and patient protections under the ACA. We remain hopeful that the courts will agree that these provisions are constitutional and must remain in effect.  It is anticipated that the Supreme Court will ultimately decide whether the ACA’s coverage requirements and other patient protections will be upheld but that decision may be many months, even years, away.

For now, the ACA’s essential protections and programs remain in effect. As this case moves forward, we will continue to advocate for patients whose lives and health depend on what the courts decide on the ACA’s coverage and patient protections.


About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.

Contact: Julie Hirschhorn, (202) 261-4523,