After judge’s ruling against ‘Obamacare,’ what happens now?

The Affordable Care Act that protects people with pre-existing conditions is at risk after a federal judge in Texas ruled it unconstitutional

The future of the Affordable Care Act is threatened - again - this time by a ruling Friday from a federal district court judge in Texas.

Judge Reed O'Connor, appointed to the U.S. District Court for the Northern District of Texas in 2007 by former President George W. Bush, ruled that the individual mandate is illegal and therefore the entire law is unconstitutional.

O'Connor argued that the Supreme Court ruling was invalidated by the removal by Congress and the Trump administration of the law's signature individual mandate.

On Friday, O'Connor ruled that after Trump signed a $1.5 trillion tax bill passed by Congress past year that eliminated the penalties, the individual mandate could no longer be considered constitutional.

But the ongoing court battles over the law are likely to proceed eventually to the Supreme Court, where President Donald Trump's appointees, Justices Brett Kavanaugh and Neil Gorsuch, could rule against the law.

In court briefs, Paxton had argued that if the judge decides not to strike down the law in its entirety, he should eliminate Obamacare protections in just those states that are challenging it. But even then, the Supreme Court wouldn't hear the case before the fall of 2019 at the earliest, with a decision unlikely before the spring of 2020 - amid the presidential and congressional campaigns.

FILE - A person walks by a health care insurance office in Hialeah, Fla.

NPR's Kodjak says the state of California has already said it will appeal the ruling. But the group of Republican governors and state officials who brought the current lawsuit argue that since the penalty for not buying coverage has been reduced to zero, the mandate is no longer a tax and thus is now not allowed under US law.

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The court's ruling implicates the entire ACA, including provisions unrelated to insurance reforms, although its reasoning has been criticized, and the ruling gives little explanation for why it considered all of the ACA's provisions to depend on the continued existence of the individual mandate. No one will be getting kicked off their insurance in the short run, or likely at all.

"If this Texas decision on the ACA is upheld, it would throw the individual insurance market and the whole health care system into complete chaos", Larry Levitt, a senior vice president of the Kaiser Family Foundation, wrote on Twitter, the Times reported. So about 12 million people who gained coverage could be left uninsured.

Schumer spoke out on Meet the Press Sunday morning, pledging that his top priority when Congress returns from its holiday recess will be to pass a law preserving the Affordable Care Act, even though Schumer remains in the minority in the Senate.

Republican Sen. Susan Collins expressed similar dissatisfaction with the ruling as she dismissed the decision as "far too sweeping" and she believes it "will be overturned on appeal".

O'Connor concluded that striking down the individual mandate would necessitate throwing out the rest of the law.

Democratic attorneys general, who became the de facto defendants for the Affordable Care Act when the Trump administration refused to defend the law, have asked O'Connor for clarification of his order, as it's unclear what effect the declaratory judgment has. Trump said last week that he would be "proud" to shut down the government over border wall funding.

She added: "The midterm elections were an overwhelming affirmation that Americans want affordable health care and the incoming Democratic House will do everything in our power to ensure affordable health care for all".

Many healthcare experts are optimistic that the Affordable Care Act will survive this latest challenge.



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