Why invalidating the ACA could cause 'enormous disruption' to American health care



JUDY WOODRUFF: The debate and the battles
over the federal health care law called the Affordable Care Act, but often referred to
as Obamacare, have been a constant since it was enacted eight years ago. But, this weekend, a new round was fired in
the battle that threatens the very future of the law itself. A federal judge in Texas ruled Friday night
that the entire law is unconstitutional. And, as Amna Nawaz explains, by doing so,
the judge has triggered a flood of questions about what happens now. AMNA NAWAZ: Judy, U.S. District Judge Reed
O'Connor sided with Republicans from 20 states who brought suit against the ACA. The judge said that, since Congress originally
passed the law with the mandate to buy insurance, the law is unconstitutional without it. The decision will be appealed by other states
and congressional Democrats. But it cast doubt on the future of the insurance
markets that millions use. And the stakes go even higher. There are huge parts of the health care system,
including Medicare, Medicaid, as well as payments to doctors, hospitals, and insurers, that
are all intricately woven into the health care law. Julie Rovner of Kaiser Health News, who joined
us Friday night about the insurance markets just before this broke, is back with us now. Welcome back. JULIE ROVNER, Kaiser Health News: Thanks for
having me. AMNA NAWAZ: So, before we tackle all the potential
changes, let's just make clear what this means right now. Has anything changed immediately as a result
of this ruling? JULIE ROVNER: No, nothing has changed immediately. The Trump administration put out a statement
Friday night and another statement today that said, while this case makes its way through
the courts, we will continue to enforce the law as it is written. The president, however, has made it clear
that he agrees with this decision and he has believed that the law is unconstitutional. So I suppose there's room for them to change
their minds. But, at the moment, what the Department of
Health and Human Services is saying is that everything goes as it has, until some conclusion
to this. AMNA NAWAZ: OK. So, at the moment, the law stands. But if the ruling is upheld, you have said
the potential impact is enormous. There could be enormous disruption. What did you mean by that? JULIE ROVNER: It is. Well, partly, it's because this law is so
much larger than just the parts that we talk about all the time, the insurance markets
and the people who buy their own insurance, and sometimes the Medicaid expansion. But this law made huge changes to the Medicare
program, to how pretty much every provider under Medicare is paid. It did things like allowed generic versions
of complicated biologic drugs. It renewed and change the Indian Health Service. There were enormous grants to help train health
professionals. There was a lot of money for community health
centers. All of that would go away if the entire law
was actually struck down. That is so embedded now into the health care
system, that it really would cause an enormous, enormous disruption. Almost hard to overstate how much of a disruption
it would be. AMNA NAWAZ: One of the more popular parts
of the law, right, protection for people with preexisting conditions, those go away too? JULIE ROVNER: Those — not only would those
go away, but there were previous protections for people with preexisting conditions in
employer-sponsored health plans that date back to 1996. And I actually discovered, doing another story
earlier this fall, that those were written into the Affordable Care Act. So, if the Affordable Care Act preexisting
condition protections for individuals went away, so would the ones for people in employment
insurance, so… AMNA NAWAZ: Something we talk about a lot
too, people under the age of 26 allowed to stay on their parents' insurance. I just want to be clear about this. That also would go away if the ruling is upheld. JULIE ROVNER: The requirement would go away. Presumably, employers could continue to allow
it if they wanted to. But the requirement that employers offer it
to parents of children up to age 26 would go away. AMNA NAWAZ: You mentioned drug pricing. That has been a key part of this administration's
agency priority at HHS there, Health and Human Services. What would this ruling — if it's upheld,
what would it do to their ability to try to lower some of those drug prices? JULIE ROVNER: Well, it would completely undercut
a lot of what the administration is trying to do on drug prices, because most of the
authority the administration is using his authority that Congress granted them in the
Affordable Care Act. This is getting to be a refrain. (LAUGHTER) JULIE ROVNER: A lot of the things that the
administration is trying to do are with the — what was allowed under that law. So it would really make it very difficult
for a lot of the — a lot of Republican efforts. It's important to remember that, even though
this law passed with only Democratic votes, the Democrats wrote it trying to appeal to
Republicans. And, indeed, there are parts of it that Republicans
like a lot. AMNA NAWAZ: It's impossible to take the politics
out of this. This was an effort led by Republican state
attorneys general and Republican governors. Is there a countereffort now by Democrats
to try to preserve the law? JULIE ROVNER: Yes, actually, that's who's
defending the law in court are Democratic attorneys general, because the Trump administration
decided not to defend the lawsuit. They said, maybe the whole law shouldn't go
down, but we think that perhaps the preexisting condition protections, things that were so
intricately tied to that mandate, that maybe those should be struck down. So the Democratic attorneys general said,
we would like to come in and defend the entire law. And the judge said OK. So it's basically right now Republican attorneys
general vs. Democratic attorneys general. AMNA NAWAZ: So there are a lot of ifs built
into this conversation. If the ruling is upheld, right, the next place
it could go is an appeals court. There's also the potential that it ends up
before the Supreme Court. They have weighed in on the Affordable Care
Act before. Do we know what would happen if it ends up
before this court? JULIE ROVNER: We don't really know, but it's
been to the Supreme Court twice, and it's been upheld twice. And even people who were on the side of striking
the law down or parts of it down before say that this particular case is pretty weak. So there is kind of an expectation that, if
it got to the Supreme Court, that the Supreme Court would overturn it. However, we don't know how long that might
take, and there might be a different Supreme Court by the time the law were to get there. AMNA NAWAZ: We have no idea what's ahead,
but you will be tracking it all for us. Julie Rovner, very, very good to see you again. JULIE ROVNER: Nice to be here.

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