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'The Judge Got It Wrong': Payers, Providers Pan ACA Ruling

Analysis  |  By John Commins  
   December 17, 2018

A federal judge's ruling that the Affordable Care Act is unconstitutional was greeted with a chorus of boos from key stakeholders, who are hoping the ruling is reversed on appeal.

Payers and providers are presenting a united front in their condemnation of a federal judge's ruling that the Affordable Care Act is unconstitutional.

U.S. District Judge Reed O'Connor in Fort Worth issued the ruling late Friday, on the eve of the final day of open enrollment for ACA coverage. He sided with Republican plaintiffs in 20 states who argued that the entire ACA was rendered invalid when Congress zeroed out the financial penalties tied to the individual mandate.

California Attorney General Becerra, who with 15 other states and the District of Columbia intervened in defense of the ACA, has already said he would appeal the ruling, which he called "an assault on 133 million Americans with preexisting conditions, on the 20 million Americans who rely on the ACA for healthcare, and on America's faithful progress toward affordable healthcare for all Americans."

Related: Judge Rules ACA's Individual Mandate Unconstitutional, Declaring Entire Law Invalid

Related: ACA Exchanges 'Still Open for Business' Despite Dramatic Ruling

Related: More to Come This Week on That ACA Ruling, But Perhaps Not an Appeal

However, the ruling has created uncertainty about the future of the ACA, even as many legal experts question O'Connor's reasoning and predict the ruling will get tossed out upon appeal.

Here's a roundup of reactions from key stakeholders, many of whom filed amicus briefs urging O'Connor to reject the plaintiff's complaint against the ACA:

Rick Pollack, president and CEO of the American Hospital Association:

America's hospitals and health systems are extremely disappointed with (Friday's) federal district court ruling on the constitutionality of the Affordable Care Act. The ruling puts health coverage at risk for tens of millions of Americans, including those with chronic and pre-existing conditions, while also making it more difficult for hospitals and health systems to provide access to high-quality care.

We strongly disagree with the ruling and urged the court not to accept the plaintiff’s severability argument in an amicus brief filed earlier this year along with other national organizations representing hospitals and health systems. We join others in urging a stay in this decision until a higher court can review it and will continue advocating for protecting patient care and coverage.

Bruce Siegel, MD, president and CEO of America's Essential Hospitals:

U.S. District Judge Reed O'Connor's ruling is a profoundly troubling development that threatens to leave millions of Americans—including many with pre-existing conditions—little hope for affordable health care coverage and financial stability.

Through the Affordable Care Act’s marketplace and Medicaid expansion, the nation has made significant gains in reducing the ranks of the uninsured. Those gains have translated to better health and productivity for hard-working people who once could not afford the high cost of coverage. We must not return to a time when the emergency department was their only option for care.

The nation’s essential hospitals always will work to meet their mission of caring for those who face economic and social hardships. But the crushing rise in the number of uninsured patients likely to follow this decision, absent a higher court’s reversal, would push these hospitals to the breaking point. Communities across the country are in jeopardy.

Chip Kahn, president and CEO of the Federation of American Hospitals:

The judge got it wrong. FAH believes this ruling would have a devastating impact on the patients we serve and the nation’s health care system as a whole.

Americans deserve access to affordable coverage so they can get the care they need, including consumer protections such as pre-existing conditions. Millions have gained coverage since the passage of the ACA, and this ruling could reverse that progress.

Having this decision come in the closing hours of open enrollment also sows seeds of unnecessary confusion.

Barbara L. McAneny, MD, president of the American Medical Association:

"(Friday's) decision is an unfortunate step backward for our health system that is contrary to overwhelming public sentiment to preserve pre-existing condition protections and other policies that have extended health insurance coverage to millions of Americans.

It will destabilize health insurance coverage by rolling back federal policy to 2009. No one wants to go back to the days of 20% of the population uninsured and fewer patient protections, but this decision will move us in that direction.”

The AMA will work with patient and other health stakeholder groups in pursuing an appeal and reversal of this unfortunate decision at the district court level.

Ana María López, MD, President, American College of Physicians:

If this ruling stands, patients could once again be turned down or charged more for preexisting conditions, and insurers would no longer be required to cover essential benefits like prescription drugs and doctor visits. Additionally, premium subsidies to make coverage affordable would end; insurers would pull out of the marketplaces; and annual and lifetime limits on coverage would return. Federal funding for Medicaid expansion would also be terminated, and seniors would no longer have access to no-cost preventive services.

While ACP hopes and anticipates that this decision by a single federal judge in Texas will be reversed on appeal, we take nothing for granted and will be doing all that we can to ensure that patients do not lose current law protections.

Matt Eyles, president and CEO of America's Health Insurance Plans:

The district court's decision is misguided and wrong. This decision denies coverage to more than 100 million Americans, including seniors, veterans, children, people with disabilities, hardworking Americans with low-incomes, young adults on their parents' plans until age 26,and millions of Americans with pre-existing conditions.

We argued in an amicus brief before the court that provisions of the Affordable Care Act affecting patients with pre-existing conditions, and those covered by Medicaid and Medicare should remain law regardless of what the court ruled on the individual mandate. Unfortunately, this ruling harms all of these Americans.

This is just the first step in a lengthy legal process. AHIP will continue to engage as this decision is appealed.

Scott Serota, president and CEO of the Blue Cross Blue Shield Association:

While we are extremely disappointed in the court's ruling, we will continue to work with lawmakers on a bipartisan basis to ensure that all Americans can access the consistent, quality health coverage they need and deserve.

(Friday's) federal district court ruling in a case challenging the Affordable Care Act is the first step in what we expect will be a lengthy legal process. Blue Cross and Blue Shield members can be assured that their health coverage and the financial assistance they may receive to help them afford it remains in place despite this ruling, and patients will continue to receive the care they need. Open enrollment for 2019 individual coverage also is unaffected, and BCBS companies will continue to help consumers find the coverage they need at the best possible price.


“The judge got it wrong. ”

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


AMA President Barbara L. McAneny, MD, calls the ruling 'an unfortunate step backward for our health system that is contrary to overwhelming public sentiment.'

AHIP President and CEO Matt Eyles called O'Connor's decision 'misguided and wrong.'

AHA President and CEO Rick Pollack calls for 'a stay in this decision until a higher court can review it.'

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