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March 26, 2019

Trump Administration Asks Judiciary to Invalidate Entire ACA

On Monday, March 25, the Trump Administration alerted a federal appeals court that it believes that the entire Affordable Care Act should be invalidated. NPAF’s statement is below. 


With a two-sentence letter to the United States Court of Appeals for the Fifth Circuit, the Trump Administration declared its intent on Monday afternoon to support a full repeal of the Affordable Care Act (ACA).


If the judiciary were to declare the ACA invalid, the entire American health care system would destabilize.  According to the most recent estimates from the Congressional Budget Office (CBO), a repeal of the ACA would result in an additional 32 million people losing their insurance coverage by 2026, as compared to the number who would be projected to be uninsured under current law.  CBO also estimates that by 2026, a full repeal would cause premiums to double.


As we have noted in previous statements, these changes would not affect an isolated part of the American family’s health care budget. Instead, it would wreck complete disaster on families’ lives and financial trajectories.


“Health coverage changes a family’s entire circumstances and opens new economic opportunities. At Patient Advocate Foundation (PAF), we’ve witnessed firsthand the profound affect that access to health care has on patients,” said Alan Balch, CEO.  “Our case managers have worked with patients whose untreated conditions kept them housebound, until access to health care managed their symptoms and put them back into the workforce. We’ve worked with patients whose health insurance meant they could go back to school and rise to the next level in their career.”


Of course, invalidating the ACA would not only eliminate federal funding for the Marketplace. The lawsuit specifically takes aim at coverage and protections for patients with preexisting conditions.


In an internal survey of PAF case managers, eliminating preexisting conditions protections was seen as the largest threat to the patients served by the organization. Case managers worked with hundreds of patients who were either denied coverage because of preexisting conditions or were offered coverage with prohibitively high premiums.


‘We have long worked with patients for whom meaningful health coverage was not possible. They were low-income, sick or had multiple conditions. Each day they lived with the constant worry of a health crisis leading to financial ruin,” said Balch. “By allowing insurers to discriminate against people with preexisting conditions, the Administration will thrust millions of Americans back into that terrible reality.”


Under a full repeal, federal funding for Medicaid expansion would also disappear. Thirty-seven states have expanded their Medicaid program. In some states, the Medicaid expansion rollback could be automatic. At least nine states—Arkansas, Arizona, Illinois, Indiana, Michigan, New Hampshire, New Mexico, Virginia and Washington state—have laws requiring them to reduce or eliminate Medicaid eligibility and/or benefits for the expansion population if the federal government reduces its contribution. However, even absent such legal clauses attached to a state’s expansion program, without federal funding, experts agree that most states would not be able to maintain a Medicaid expansion.


Crucially, the Medicaid program covers nearly half of the nation’s children. Not only that, but in most states, Medicaid also provides access to specialized therapeutic services for children with disabilities, along with covering home care visits and other essential support services. In lower-income households that have private insurance coverage for basic health needs, Medicaid provides supplemental coverage. Curbing Medicaid coverage will leave these children behind.


A repeal would also harm Medicare enrollees. The ACA gradually closed the infamous Medicare “donut hole,” in which enrollees had to pay the full cost of their prescription drugs before reaching catastrophic coverage. It also allowed for no-cost-sharing for certain wellness and preventative office visits and treatments.


Texas and 19 other states sued the federal government in February 2018, claiming that the ACA is unconstitutional because the recent tax law eliminated the penalty for not having health insurance. If the argument prevails in court, it would eliminate the ACA provisions that ban insurance companies from denying coverage based on preexisting conditions or from charging higher rates based on their health status.


The Trump Administration had previously supported declaring the individual mandate and preexisting conditions protections unconstitutional; its latest letter to the court indicates support for full repeal of the entire law, with intention to file a full brief at a later time.