Late on December 14, 2018, the day before the 2019 Affordable Care Act (ACA) open enrollment period closed, a judge ruled in Texas vs. United States that the ACA in its entirely was unconstitutional. Earlier this year 20 Republican state attorneys general filed the lawsuit challenging the constitutionality of the ACA now that the Tax Cuts and Jobs Act, the tax reform package passed in December 2017, zeroed out the individual mandate penalty as of January 1, 2019. In his decision, the Texas judge referenced a prior Supreme Court ruling that the ACA is a tax and found that the individual mandate was not severable from the rest of the law, forcing him to find the entire ACA unconstitutional.
The judge did not issue an injunction that would have immediately ceased implementation of the ACA. Therefore, there will be no immediate impact on patients or providers. Democratic state attorneys general plan to appeal the ruling, and it may go all the way to the Supreme Court. As the appeals process proceeds, people will still have coverage through ACA exchange plans and the Medicaid expansion. Insurers must still follow ACA patient protections, like the ban on pre-existing conditions exclusions and lifetime caps. The payment reforms included in the law, including demonstrations run by the Center for Medicare and Medicaid Innovation, will also continue.
AASLD will be monitoring the case as it works its way through the appeals courts and will notify members of any developments, particularly those that will impact patient access to appropriate care.