Texas v. United States: healthcare for thousands in limbo as the court deliberates

Back • October 4, 2019 • Uncategorized

Texas v. United States considers the constitutionality of the individual mandate within the Affordable Care Act (ACA) and whether the mandate, if deemed unconstitutional, is severable from the rest of the ACA. The 5th Circuit of Appeals should issue their decision in the coming weeks. 

Impact of an ACA Repeal on Connecticut Families and Children

A total collapse of the ACA would have troubling impacts for Connecticut’s  families and children. Approximately 111,000 people purchase insurance through the state’s health care marketplace, Access Health CT. An additional 268,000 residents receive coverage through HUSKY D, Connecticut’s Medicaid expansion program, which the ACA made possible.

While CT law already prohibits insurers from denying coverage to residents with pre-existing conditions and clarifies state-mandated essential health benefits, these protections only apply to the 35 percent of people with fully-insured plans regulated by the state. Other employer-based plans are regulated exclusively by federal laws. In the absence of the ACA, insurers could exclude essential services from coverage and place 24 percent of CT residents at risk of losing insurance or facing higher premiums because they live with declinable pre-existing medical conditions.

How We Got Here & Next Steps

A group of 20 states filed the lawsuit, arguing that the ACA is unconstitutional since the federal tax overhaul in 2017 zeroed out the penalty for failure to obtain health insurance, known as the “individual mandate.” The plaintiffs argued that because the individual mandate is critical to the functioning of the ACA, the health law cannot stand without the mandate. In December 2018, the district judge issued a ruling in agreement with the plaintiffs. After his ruling, which declared the entire ACA invalid, the case was sent to the 5th Circuit Court of Appeals. The ruling also prompted 21 state attorneys general, including Connecticut’s William Tong, to intervene in the case, arguing the ACA should remain valid. For further details regarding this process, see an explanation by Health Affairs

In practical terms, if the court invalidates the mandate and allows it to be severed from the rest of the ACA, little will change. However, if the court determines the ACA cannot function without the individual mandate in place, this would put coverage at risk for millions. Regardless of the outcome, it’s highly likely that the Supreme Court will be asked to reconsider the case, meaning the legal battle over the ACA will continue into late 2020, placing the health coverage for thousands of families in a continued state of uncertainty.