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Hospital Groups Thump Trump DOJ on ACA Reversal

Analysis  |  By John Commins  
   March 27, 2019

Showing a united front, the nation's largest hospital associations roundly condemned of the DOJ's decision to abandon its defense of the ACA.

The decision this week by the Department of Justice to drop any and all defense of the Affordable Care Act was met with scorn and dismay from the nation's hospital lobby.

American Hospital Association President and CEO Rick Pollack called the DOJ's about-face on the ACA defense "unprecedented and unsupported by the laws or the facts."

"America's hospitals and health systems oppose the Department of Justice's misguided decision calling on the courts to strike down the Affordable Care Act in its entirety," Pollack said in a media release.

"If courts were to adopt the DOJ position, Medicaid expansion would be reversed and protections for people with chronic and pre-existing conditions would cease to exist," Pollack said. "Millions of Americans would lose the coverage they have relied on for years. We have made too much progress in coverage and access to care for patients to go backwards."

Related: Invalidating ACA Would Undercut Parts of Trump's Own Health Policy Agenda

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The DOJ had argued in District Court proceedings last fall that most of the sprawling healthcare legislation should remain intact, even if the ACA's individual mandate were to be struck down in light of Congress zeroing out its tax penalty. Only the ACA's community-rating and guaranteed-issue provisions—which protect consumers with preexisting conditions—should fall with the mandate, the DOJ had argued.

District Judge Reed O'Connor's decision last December went much further than the DOJ had urged, declaring the entire ACA invalid, as the Texas-led coalition of plaintiff states had requested.

Now that an appeal is pending at the Fifth Circuit, however, the DOJ has decided that it agrees with the plaintiffs' argument and O'Connor's decision after all.

Federation of American Hospitals President and CEO Chip Kahn called the reversal "unfortunate but not unexpected considering (the Trump administration's) long-held views on the health law."

"Millions of Americans depend on the ACA to access healthcare and rely on the insurance protections afforded in the law," Kahn said. "We continue to believe the district court judge got it wrong and trust that this decision will be overturned in the appeals process."

Beth Feldpush, senior vice president of policy and advocacy at America's Essential Hospitals, called the Trump administration's position "untenable for our hospitals and their patients."

"It threatens to reverse important gains in health and healthcare access and take us back to a time when the emergency department was the only option for millions of people," Feldpush said. "That’s unsustainable and would push our hospitals to the breaking point as they struggle with the swelling costs of uncompensated care."

Sister Carol Keehan, DC, president and CEO of the Catholic Health Association of the United States, called the reversal "unconscionable and immoral." 

"The Department of Justice, now backtracking from its prior legal stance to argue instead that the entire Affordable Care Act should be struck down, is stunning," Keehan said. "The time has come for our government to stop playing politics with people's health and livelihoods."

Keehan said the elimination of the ACA would bring back a litany of healthcare access and coverage problems that preceded the sweeping legislation, including the loss of guaranteed protections for 130 million people with pre-existing conditions and the elimination of Medicaid coverage for 17 million poor people.

"We would return to the era of insurance companies defining what they cover rather than being required to offer plans that provide true health security," she said. "The continuing innovation to shift the healthcare system toward providing more affordable and quality health care to people in this country would also be lost."

Keehan said the CHA would be filing a friend-of-the-court brief " to alert the Fifth Circuit to the dire consequences of upholding the District court's decision."

"If the last few years of debating the Affordable Care Act and all its provisions have taught us anything, it is that Americans value their healthcare," Keehan said. 

“It is unconscionable and immoral for the Administration to support upending the entire health care system in the United States.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Photo credit: Mark Van Scyoc


AHA's Rick Pollack warns that if an appeals court adopts the DOJ's position, Medicaid expansion would be reversed and protections for people with chronic and pre-existing conditions would vanish.

FAH CEO Chip Kahn called the reversal 'unfortunate but not unexpected considering (the Trump administration's) long-held views on the health law.'

Catholic Hospital Association is readying an amicus brief urging a federal appeals court to strike down a lower court ruling invalidating the ACA.

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