U.S. Supreme Court
Over four dozen economic and policy experts, as well as a number of groups representing insurers, hospitals and consumers, asked the U.S. Supreme Court to uphold the Affordable Care Act and expedite a review of a Republican lawsuit challenging the constitutionality of the decade-old law.
"Leaving the ACA in limbo for another year or more needlessly threatens injury to every kind of participant in the U.S. healthcare system — from insurers, to consumers, to providers, to states" — 56 economics, health policy and legal scholars said in an amicus brief filed with the Supreme Court.
A coalition of Republican state attorneys general and the Trump administration are seeking to invalidate the ACA — former President Barack Obama's signature legislative achievement.
But voiding the ACA would increase costs for insurers, healthcare providers, states and the federal government — "all of whom have made extensive accommodations to incorporate the law into their business and administrative practices," said the economic and policy experts, which included three Nobel laureates and a number of former high-ranking White House officials from Republican and Democratic administrations.
Such an action "makes no economic sense," they said.
"The confusion and chaos that such a move would cause is difficult to imagine, a priori, but is certainly a maelstrom that Congress did not intend," the experts said.
In their lawsuit, the Republican state attorneys general and the Trump administration argued that when Congress zeroed out the ACA's penalty for forgoing health coverage — the individual mandate — in the 2017 tax reform bill, that action rendered the remainder of the 2010 healthcare law unconstitutional.
A Texas district judge agreed, ruling in December 2018 that the individual mandate could not be severed from the ACA and therefore, the entire law was invalid.
A year later, a three-judge panel from the U.S. Court of Appeals for the 5th Circuit determined that only the individual mandate was invalid and sent the case back to the lower court, telling the Texas judge to use a "finer-toothed comb" to reassess whether other parts of the ACA should be saved.
But such a "do-over" would raise the prospect of years of further litigation and unnecessarily prolong the uncertainty of the lawsuit, America's Health Insurance Plans told the Supreme Court in its amicus brief.
U.S. Supreme Court
The insurance group, along with the 56 economic and policy experts and other organizations, sided with a cadre of Democratic state attorneys general and Democrats in the U.S. House of Representatives in urging the Supreme Court to expedite its review of the case.
The Trump administration and the Republican attorneys general asked the Supreme Court to take its time and allow the Texas judge to first parse through the ACA and then let the 5th Circuit have another crack at reviewing the lower court's work — meaning it would be unlikely for the case to be settled before the 2020 U.S. elections in November.
Without clarity about whether the entire ACA will be wiped off the books, hospitals and healthcare providers will be left questioning whether they should invest in initiatives that rely on the law's provisions, a group of hospital associations said in an amicus brief.
"The court should step in — now — to avoid that unnecessary and untenable result," they urged the justices.
A big concern for hospitals, whose operating decisions are inextricably tied to the ACA, is whether they will need to have extra funds on hand to pay for expenses currently covered by the law's Medicaid expansion and other insurance reforms if those programs go away, the hospital associations told the Supreme Court.
The lingering uncertainties created by the district court's and 5th Circuit's rulings are particularly detrimental for patients and survivors of cancer and other diseases, the American Cancer Society, the American Heart Association, the United Way and 17 other groups said in a brief filed with the Supreme Court.
They noted that the power to make laws rests with Congress, which rejected the idea of repealing and replacing the ACA, despite a number of attempts by Republicans to do so.
Congress passed the ACA to improve the U.S. health insurance market, so the courts must interpret the act consistent with that goal, the medical, research, mental health and other healthcare organizations said.
"Invalidating the ACA over Congress' clear intent to the contrary — as the district court did and as the court of appeals' ruling leaves open — has life-altering implications for patients with chronic diseases," they said.
Americans, particularly older adults, have been plunged into an "abyss of prolonged uncertainty" and cannot make informed decisions about their coverage and healthcare while the legal viability of the ACA hangs in the balance, the AARP and other groups said in their brief.
They noted that some of the unknowns that await Americans are whether prescription drugs and preventive services will become even more expensive or if they will be unable to change jobs for fear of losing health insurance.
The ambiguity over the continued existence of the ACA may cause community-based health plans to leave certain markets or keep them from entering new ones, groups representing those entities said in their brief.
Progress stalls in narrowing racial gaps
Meanwhile, the progress that was observed in the early years of the ACA in narrowing the racial disparities gap in access to coverage has stalled under the Trump administration, according to a new report from the nonprofit, nonpartisan Commonwealth Fund.
That progress has even eroded in some cases, the analysis showed.
Much of that decline was attributed to the repeal of the individual mandate's tax penalty, the administration's reductions in funding for outreach and enrollment assistance and its expansion of short-term plans — policies that often do not cover Americans with preexisting medical conditions.