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Pivotal Court Case Could Determine The Future Of The Affordable Care Act

Jun 28, 2018

Connecticut is among the states that have intervened in what could be a key legal fight over the future of the Affordable Care Act. If the lawsuit continues past a United States district court, advocates are concerned that more ACA provisions could be cut -- like the one that protects people with pre-existing conditions.

President Donald Trump has tried to fulfill a key campaign promise of repealing the ACA since he became president. So far, efforts to do that in Congress have largely been in vain. Last week at the Nevada GOP convention, Trump laid the blame squarely on Arizona Senator John McCain’s dramatic ‘no’ vote last year.

“Nobody talked to him,” Trump said. “Nobody needed to—it was a done deal. And then he walked in: ‘thumbs down.’ It’s alright because we’ve essentially gutted it anyway.”

Professor Abbe Gluck, an expert on health law and policy at Yale Law School, has filed legal briefs in 2012 and 2015 Supreme Court challenges to the Affordable Care Act.

“The administration’s entire strategy is do whatever it can outside of Congress, because it could not get the votes in Congress, to destabilize the law so that it kind of collapses on its own,” Gluck said.

The latest legal efforts to gut the law come in Texas vs the United States. The plaintiffs -- 20 state attorneys general, all from states with Republican governors -- argue that a federal mandate that forces citizens to buy health insurance is unconstitutional. If the mandate is ruled unconstitutional, they argue, the rest of the law should also be invalidated.

On the other side of the suit, United States Attorney General Jeff Sessions has said that the Trump administration won’t defend the ACA, but that if the court agrees and eliminates the individual mandate, some other key parts of the Act won't apply, including protections for people with pre-existing conditions.

“So the Department of Justice is sort of trying to ‘split the baby’ by saying, ‘We’re not getting involved but we should kill the major reforms of the statute.’ That’s just as irresponsible as the Texas position,” Gluck said.

That outcome could be serious for people with pre-existing conditions.

Currently, the law says that insurers can’t charge them more, or refuse them coverage. But if the law is struck down, those protections don’t apply any more. Sixteen blue states, including Connecticut, have filed a brief in the case defending the ACA. Because of the political nature of the case, the outcome is hard to predict.

“This case is in front of a judge in Texas who has handed down some rulings that have been adverse to the Affordable Care Act in the past,” Gluck said. “That’s why Texas chose to file in this district — to get this very judge.”

Advocates for the ACA are split over arguments that the mandate to buy insurance is essential to the success of the program.  Without it, some say, health insurance will only be for the sickest among us -- and that could cause the program to fail.  Others argue it is still possible to stablize insurance markets without the guarantee that all of us will buy in.

This story has been corrected and edited from its original version for clarity and accuracy.