September 21, 2018

Democratic, GOP attorneys general square off in Texas showdown over ACA

06 September 2018, 09:37 | Silvia Roy

People hold a rally in support of Obamacare

Healthcare isn't a game. The Texas ACA lawsuit could be catastrophic for public health

But attorneys for the state of California - which has joined with 15 Democratic-led states and the District of Columbia to defend the Affordable Care Act - urged O'Connor to instead focus on the intent of the lawmakers who wrote the 2017 tax law. A decision is expected in coming weeks, but Paxton guessed the case would likely end up back at the U.S. Supreme Court. The Justice Department agrees that the individual mandate is rendered unconstitutional but argues that invalidates only the law's protections of those with pre-existing conditions.

The Republican-led coalition of states is arguing that the Obama administration and a majority of U.S. Supreme Court justices said in prior cases that the mandate is constitutional because its penalty is a tax and the mandate is essential to creating effective health insurance markets.

Texas Attorney General Ken Paxton (center) is leading the lawsuit.

The Trump administration is pushing forward with short-term, limited-duration insurance and association health plans as an alternative to comprehensive but costly policies under the Affordable Care Act.

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Large majorities of Americans say it is "very important" to retain the ACA provisions that prevent insurance companies from denying coverage based on a person's medical history (75%) and from charging sick people more (72%).

The case has always been considered a tough one for the plaintiffs, who have to prove the now-gutted, zero-dollar individual mandate is an essential part of the ACA and argue that Congress' vote to eliminate the individual mandate was a vote to repeal the landmark law altogether. Notably, this issue transcends party lines: Most Democratic and independent voters, and almost half of Republican voters, said a candidate's position on continued protections for pre-existing conditions is either the "single most important factor" or a "very important factor" in their 2018 vote. "By significantly increasing health insurance coverage, the requirement, together with other provisions of this Act, will minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums".

The consumer protections targeted by the administration are central to Obamacare and transformed the health insurance landscape. An insurance attorney with ties to the case said for insurers the sweeping impact of a reversal of the entire law would deal a hefty blow to insurers of Medicaid, Medicare and all the aspects of the healthcare industry touched by the ACA. They say they needed to step forward to protect the health and well-being of their residents.

"Absent the individual mandate, the ACA is an irrational regulatory regime", the plaintiffs argue in court papers.

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At the same time, by signaling he would issue a ruling soon, O'Connor assured that the lawsuit - Texas v. Azar - and its attempt to wipe out the 2010 law would continue to shadow political campaigns ahead of this November's midterm congressional elections. There is a question of timing on when and how the court rules. Less than half blame people getting more services than they really need (41%), the Affordable Care Act (39%), the Trump administration's recent actions on health care (38%), or people not shopping for lower-priced services (28%).

"This legislation is a common-sense solution that guarantees Americans with preexisting conditions will have health care coverage, regardless of how our judicial system rules on the future of Obamacare", said Sen. Health care experts, however, were quick to point out that the bill would not require insurers to cover treatment of those conditions, which could greatly limit the usefulness of the policies.

As a "fallback position", plaintiffs also made a case for ending protections for people with pre-existing conditions in the 20 states involved in the case by 2019. The team compared changes in health insurance coverage and access to and use of health care services among Latinos ages 18 to 64 before implementation of the main provisions of the Affordable Care Act (2007-2013) and after (2014-2016). The latest Kaiser Family Foundation tracking poll, released Wednesday, finds that 50 percent now view the law favorably while 40 percent see it unfavorably, with the divide still falling along partisan lines.

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