DOJ Reverses Course, Sides With Judge Striking Down ACA

The Trump administration has decided to follow in the footsteps of the federal judge in Texas who ruled the Affordable Care Act (ACA) must be invalidated. A 2-sentence letter from the Department of Justice (DOJ) noted that the administration believes the district court’s ruling should be affirmed, which would result in the entire ACA falling and millions of people losing their health insurance.

In December 2018, a federal judge in Texas ruled that when the penalty for not having health insurance was removed, the individual mandate became unconstitutional, and without the individual mandate, the rest of the ACA is invalid because the mandate was “essential” to the health law.

The letter said that the department is not “urging that any portion of the district court’s judgement be reversed.”

Matt Eyles, president and chief executive officer of America’s Health Insurance Plans, called the government’s reversal to support the district court decision is “misguided and wrong.”

“This harmful position puts coverage at risk for more than 100 million Americans that rely on it,” he said in a statement. “We will continue to engage on this issue as it continues through the appeals process so we can support and strengthen affordable coverage for every American.”

If the entire ACA is struck down, it could have lasting impacts beyond increasing the number of Americans without insurance. Dan Diamond, of Politico Pulse, pointed out on Twitter that some of President Donald Trump’s own health policies depend on either the coverage gains that happened under the ACA or work that comes out of the Center for Medicare and Medicaid Innovation (CMMI).

CMMI has been responsible for many of the value-based initiatives in the country, including bundled payment models, accountable care organizations, and primary care medical homes. These models tie payment to outcomes with the goal of improving care delivery while reducing the cost of care.

The ACA also provides protections for patients with pre-existing conditions, which remain popular with all Americans regardless of political affiliation, according to a September 2018 poll from Kaiser Family Foundation. The law also set 10 essential health benefits that insurance plans must cover, and allows young adults to stay on their parents’ insurance up to age 26.

Other, lesser known provisions of the ACA include requiring calorie counts on menu items at chain restaurants and a private space for nursing mothers to pump breast milk. The health law also authorized the FDA to approve biosimilars through a new regulatory approval pathway under the Biologics Price Competition and Innovation Act.

In December, when the federal judge struck down the ACA, the American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, and National Multiple Sclerosis Society blasted the ruling in a joint statement.

“This decision threatens to resurrect barriers to health care for people with serious illnesses including cancer, heart disease, stroke, lung disease, diabetes, and those with neurological conditions. If the ruling stands, anyone with a pre-existing condition could be charged more for health coverage or denied access to coverage altogether,” the statement said. “The court should have respected the will of Congress instead of ruling to invalidate the law at the expense of the 27 million Americans who will lose their health care by 2020, according to Congressional Budget Office estimates.”

The announcement from the DOJ comes days after the 9th anniversary of the ACA being signed into law on March 23, 2010, and the day before CMS revealed that the ACA marketplace is stabilizing with plan selections remaining steady at 11.4 million with only a slight decline of 300,000 enrollments compared with last year. In addition, CMS reported that the average total premium for plans selected through HealthCare.gov had dropped 1.5% from last year. This represents the first year that premiums had declined since the exchanges began operating in 2014 and follows 23% average premium increase in 2017 and 31% increases in 2018.

“Another year of stable enrollment through the Exchanges directly reflects the strong work CMS staff put into ensuring that Exchange consumers experience a seamless enrollment process free from unnecessary hurdles and [information technology] glitches,” Administrator Seema Verma said in a statement. “It is no coincidence enrollment remained strong when the Exchange call center maintained a record high 90% satisfaction rate and no waiting rooms were needed in the final, busiest days of enrollment.”