A federal judge recently ruled that the entire Affordable Care Act (ACA) is unconstitutional, sparking a great deal of speculation and confusion among health care advocates about the future of health coverage. We will talk in a little more detail about the ruling and potential next steps below, but it is important to start with this: as it stands, the ACA is still the law of the land.
The decision in Texas v. US, concluded that the ACA’s individual mandate is unconstitutional, but the judge stopped short of the plaintiff states’ request for a preliminary injunction, which would have put the entire law on hold. The ACA and all of the health insurance coverage gains made under it will remain in effect as this case continues to make its way through the courts.
This particular challenge to the Affordable Care Act (ACA) started last year, when 18 attorneys general, two governors and two individual plaintiffs (residents of Texas) filed a lawsuit in federal district court arguing that the individual mandate prescribed by the ACA was unconstitutional. The plaintiffs’ point in Texas v. US underscored that the individual mandate is so inextricably linked to the rest of the ACA that the individual mandate is “inseverable” and the entire law could not be upheld without it.
To understand what may happen next, it is important to note that the Department of Justice also said that it would not fully defend the ACA in this case, but also did not believe that the entire law should be struck down. In a recent move, a group of 17 Democratic attorneys general intervened to defend the ACA and are expected to file an appeal. There is also broad consensus among legal scholars and policy experts across the spectrum that the Texas decision will not survive an appeal. For a detailed analysis of the decision, see Katie Keith’s blog post in Health Affairs.
Impact on Health Centers and Patients
Most importantly for health centers and their patients, the ACA currently remains in place, but the ruling is already generating confusion and threatens the coverage and access gains health center patients have achieved thus far. Estimates are that roughly 12 million people could lose coverage gained through Medicaid expansion and 8 million people would lose access to subsidies that allow them to purchase insurance on the individual marketplaces.
We understand that health centers and patients alike might have a variety of questions in the months ahead, so as NACHC continues to monitor the Texas v. US case, as well as other ACA litigation pending in courts around the country, we encourage you to reach out to us at firstname.lastname@example.org to share your questions and concerns regarding the future of the ACA.
 State Plaintiffs are Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, and Wisconsin.