The long, legal battle over the Affordable Care Act will continue after the 5th Circuit Court of Appeals ruled the individual mandate unconstitutional yesterday, then sent the rest back to a lower court to decide the fate of the rest of it. That could well result in the entire law getting gutted, including the measure that ensures coverage for Americans with preexisting conditions.
Sens. Joni Ernst and Chuck Grassley and their Republican colleagues have promised to repeal former President Barack Obama’s legislation for years now. Since early 2018, the Trump Administration has backed legal cases to try and tear down the law, it has moved through the court system.
Rather than improve the ACA, which allows Americans to purchase government-subsidized health insurance plans in the private marketplace, Republicans repeatedly have worked to torpedo it by shortening the open enrollment period and dramatically reducing outreach on how and when to sign up for coverage.
Now, with the mandate struck down, the court-based debate is opened up to what other parts of the ACA could be deemed unconstitutional. After the 5th Circuit declined to rule on Wednesday, the case has been passed back down to a district court, and it will now fall in front of a right-wing judge who has already ruled that all of the ACA should be struck down.
Sending the Case Down?
By sending the case backwards in court, it also delays the time until this case would potentially end up in the Supreme Court.
This could be mightily important for a couple reasons.
First, it could delay the case enough that nothing will happen until after the 2020 election. This helps Trump avoid a narrative during his campaign that he and his party destroyed health care and protections for pre-existing conditions – as they have made clear they would like to.
Second, it makes the next potential Supreme Court nominee incredibly crucial. Trump getting the chance to place another far-right judge on the bench presents an even easier path to getting a partisan ruling that the Affordable Care Act, in its entirety, is unconstitutional.
Ernst often says on the campaign trail that she supports insurance coverage for pre-existing conditions, yet she has repeatedly voted to repeal the Affordable Care Act — with no tangible plan to replace it — and is supportive of the White House-backed lawsuit.
“Yes, I did vote to repeal the ACA,” Ernst said, at an October town hall.
‘It Does Nothing At All’
In 2017, the Tax Cuts and Jobs Act (TCJA) set the ACA’s individual mandate tax at $0, effectively canceling that provision of the law.
And in Wednesday’s court ruling, judges ruled the tax unconstitutional.
“All the TCJA did, with respect to healthcare, was change the amount of the shared-responsibility payment to zero dollars. Thus, despite textual appearances, the post-TCJA coverage requirement does nothing more than require individuals to pay zero dollars to the IRS if they do not purchase health insurance, which is to say it does nothing at all,” the ruling states. “This insight, that the coverage requirement now does nothing, should be the end of this case. Nobody has standing to challenge a law that does nothing. When Congress does nothing, no matter the form that nothing takes, it does not exceed its enumerated powers. And since courts do not change anything when they invalidate a law that does nothing, every other law retains, or at least should retain, its full force and effect.”
Despite creating this glitch to get the ACA into the court system, Republicans leaders have so far failed to yield a ruling on the rest of the law.
No Clear Future For The ACA
The case will now go back to a lower court for further analysis.
“The facts here are simple. This lawsuit means that the care of 1.3 million Iowans with pre-existing conditions is at risk, while insurance companies continue to profit,” said Emily Holley, executive director of Iowa Voices. “Senators Joni Ernst and Chuck Grassley have supported and ushered in this attack on our health care and now millions of Iowans’ lives are at risk.”
Protections put in place for 1.3 million Iowans with pre-existing conditions are at risk. If the court decides the law is unconstitutional, it could result in 187,000 Iowans losing coverage; 24,000 young adults dropped from their parents’ plans; 51,596 Iowa seniors forced to pay more for prescription drugs; and all Iowans over 50 potentially facing an annual $4,000 “Age Tax.”
“Joni Ernst has allowed insurance and pharmaceutical companies to call the shots since her first day in office, so it comes as no surprise that even in the face of this decision, she continues to ignore the needs of 1.3 million of her constituents. Iowans deserve better than a senator who won’t fight for them,” said Matt Sinovic, executive director of Progress Iowa.
Iowa leaders like Cindy Axne, and others, have expressed their displeasure with the latest revelation.
“Yesterday’s ruling by the Fifth Circuit is disastrous for Iowa. By continuing down a path that could lead to completely undoing the Affordable Care Act, this decision not only risks raising premiums in the short term,” said Congresswoman Cindy Axne. “But it could also eliminate protections for the 1.2 million Iowans living with pre-existing conditions, undo Medicaid expansion, and send health care costs skyrocketing across our country.”
“Everywhere I go in the Second District, the number one issue that comes up is health care. This ruling puts the courts on a path that could take away protections and health care from my friends and neighbors,” explained Rita Hart, candidate for Iowa’s 2nd Congressional district. “For many people premiums will rise, seniors will have to pay more out of pocket for prescription drugs, providers will be threatened, young people under 26 will be thrown off their parents’ insurance, and hundreds of thousands of Iowans with pre-existing conditions will lose protections.”
By Josh Cook