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Hospital Associations Urge Appeals Court to Reverse ACA Ruling

Analysis  |  By John Commins  
   April 01, 2019

National and state hospitals groups warn that invalidating the Affordable Care Act would have 'disastrous' consequences for tens of millions of Americans and the nation's healthcare infrastructure.

The nation's largest hospital associations and 24 state hospital associations on Monday filed amicus briefs urging a federal appeals court to reject a Texas court's "judicial repeal" of the Affordable Care Act.

"If upheld, it will unwind eight years of progress under the ACA's broad set of reforms," read the joint amicus brief submitted by the American Hospital Association, Federation of American Hospitals, the Catholic Health Association of the United States, America's Essential Hospitals, and the Association of American Medical Colleges.

"And if upheld, it will cause tens of millions of patients to lose their health insurance, returning them to the ranks of the long-term uninsured and putting their health at risk," the associations said.  

U.S. District Judge Reed O'Connor last December declared the entire ACA invalid, as the Texas-led coalition of plaintiff states had requested. The ruling was appealed to the 5th U.S. Circuit Court of Appeals by a California-led coalition of states intervening in defense of the ACA.

The Department of Justice mounted a partial defense of the ACA, arguing 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.

O'Connor's ruling invalidating the ACA went much further than what DOJ had urged. Last week, however, DOJ reversed course and notified the appeals court that it agrees with the plaintiffs' argument and O'Connor's ruling, and would entirely abandon its partial defense of the ACA.  

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The AHA-led amicus brief said that repealing the ACA only benefits the "plaintiffs' idiosyncratic health-policy preferences."

"But for the rest of the country, which has benefitted from expanded health-insurance coverage, the birth of a stable individual-insurance market, an expanded Medicaid safety net, and many other protections, it would be disastrous," the brief read.

"It would result in more Americans going without basic medical care and more Americans waiting to seek care until they are seriously ill, placing their health at greater risk and making it harder to treat their conditions successfully," the brief said.

In a separate amicus brief, also filed Monday, 24 state hospital associations also urged the appellate court to reverse O'Connor's ruling.

"This court should reverse the district court’s order striking down the ACA," the brief read. "If the court holds the minimum coverage provision unconstitutional, it should sever that one provision and leave the rest of the law intact."

"Any other ruling would disrupt nine years of innovations that have become enmeshed in the health care landscape, wreak havoc in healthcare delivery in this country, and subvert the will of Congress," the 24 hospital associations wrote.

“If upheld, it will unwind eight years of progress under the ACA's broad set of reforms.”

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


An AHA-led coalition of major hospital groups filed a joint amicus brief urging an appeals court to overturn a lower court ruling invalidating the ACA.

The hospital groups contend that the lower court's ruling has no basis in the law, subverts the intent of Congress, and would greatly harm healthcare access and delivery.

A separate amicus brief filed jointly by 24 state hospital associations reiterated the providers concerns and urged the court to reverse the ruling.

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