ACP Says Court Ruling on the ACA's Insurance Mandate Threatens Coverage, Benefits, and Patient Protections

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Federal appeals court rules individual mandate is unconstitutional, sends it back to a lower court to decide constitutionality of the entire law

Jan. 10, 2020 (ACP) – The American College of Physicians is warning that the survival of the Affordable Care Act (ACA) is at risk after a federal appeals court left its fate uncertain.

At issue is whether the ACA can exist without the individual mandate, which the federal appeals court said in its ruling was unconstitutional. The legal issue threatens ACA benefits such as preexisting condition protections, essential benefit requirements and funding for Medicaid expansion.

“The overturning of the ACA would be tragic and harmful to millions,” said Dr. Robert McLean, president of ACP. “We have no choice but to speak up.”

On Dec. 18, a three-judge panel of the U.S. Court of Appeals for the Fifth Circuit ruled that the ACA's mandate requiring insurance coverage violates the Constitution “while sending back to a lower court the question of whether the rest of the law can remain without it,” according to The Washington Post.

As the Post notes, Congress has already zeroed out the individual mandate's financial penalty. However, it reports, “the panel's 2-to-1 ruling leaves the rest of the sprawling statute in limbo, catapulting questions of insurance coverage and consumer health-care protections to the forefront of the 2020 presidential and congressional campaigns.”

ACP has taken a strong stand on this court case since the state of Texas filed a lawsuit challenging the ACA in federal court last December. ACP joined 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.

As McLean explained, amicus briefs, or “friend of the court” briefs, “are legal arguments provided to courts explaining the rationale for positions in a case. In legal cases that touch upon health care issues where the ACP has established policy, such as our support of the ACA, the ACP joins with other organizations to file such amicus briefs. Typically, we work with other professional societies.”

The amicus brief in this case states: “Even if this Court concludes 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.”

The brief also reminds judges that the health and lives of millions of people are at stake. If the ACA is struck down, Americans will be in danger of losing its many protections, including mandatory coverage for preexisting conditions, requirements that insurers cover a core set of essential medical services, funding for Medicaid expansion, Medicare coverage of preventive services at no out-of-pocket cost for seniors, and bans on insurers imposing annual or lifetime limits on coverage.

What's next? After the case is sent back to the district court to answer the question of whether the rest of the law can remain it may eventually make its way to the U.S. Supreme Court, but that date could be months or years away.

“We feel obligated to continue to advocate for as long as necessary,” McLean said. “ACP has a respected voice and will continue to use it appropriately.”

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