Jeremy McClain, NACHC Legal Research Analyst, co-authored this blog post.
The Supreme Court this week heard oral arguments in the case of California v. Texas, a case in which the Trump Administration and 18 state attorneys general are asking the Court to strike down the entire landmark Affordable Care Act (ACA) as unconstitutional. The provisions of the ACA, passed in 2010, have become so intertwined with our health care over the intervening years that, should the Administration prevail, the entire health care system could be thrown into disarray, with some 21 million people becoming uninsured. Additionally, many more could be affected by being denied coverage because of a pre-existing health condition, as well as the loss of other important safeguards. Earlier this year, NACHC weighed in on the importance of preserving the ACA by filing an amicus brief with the Court, and we continue to follow developments closely.
The suit poses two central questions about the validity of the ACA. First, whether the individual mandate to purchase health insurance was rendered unconstitutional when Congress zeroed out the tax penalty in the 2017 Tax Cuts and Jobs Act (TCJA). Second, if the mandate is found unconstitutional, is the particular provision so inextricably linked to the rest of the ACA that the entire law must be struck down? Or, as many in the legal community believe, can the mandate be “severed” and the rest of the law upheld?
Certainly, a lot is riding on these questions for tens of millions of Americans — including for our health centers and their patients. While millions of people would lose their private insurance, the biggest loss of coverage would be among low-income adults who became eligible for Medicaid under the law’s expansion of the public insurance program. A complete repeal of the ACA would also invalidate key health center program provisions such as the mandatory CHC Fund, funding for the National Health Service Corps and the Teaching Health Centers Graduate Medical Education program, as well as health centers’ Medicare PPS reimbursement mechanism, and updates to the 340B program — effectively crippling health center operations that now serve nearly 30 million people nationwide.
But let’s be clear: for now, at least, the ACA is still the law of the land. And as we noted in a previous blog post, the 8th Open Enrollment Period (OE8) under the ACA is currently underway. Millions of Americans have lost their livelihoods, not to mention their insurance coverage as a result of the COVID-19 pandemic. Having affordable, comprehensive coverage is more important than ever.
A final decision on the case isn’t expected until next spring. Meanwhile, President-elect Joe Biden has promised to expand the law when he takes office in January. We will keep you updated as the situation develops.