Updates from the ACA court hearing - State of Reform
10 July, 2019, 15:24
Hanging in the balance as the judges mull what they heard: the subsidized health coverage of about 1 million Texans, a suite of low-priced services guaranteed to all individuals with health insurance, and the law's popular protections for patients with preexisting conditions. A third, appointed by Democratic President Jimmy Carter, stayed silent throughout the almost two-hour oral argument hearing in New Orleans, which follows a December decision by federal Judge Reed O'Connor of the Northern District of Texas calling for the law to be struck down.
Although a decision by the appellate court could take months, the ruling-whatever the outcome-is expected to be appealed to the U.S. Supreme Court, which could hear arguments and rule on the case amid the 2020 presidential campaign.
The Supreme Court has twice upheld the health care law, but overturning it would have significant ramifications for the nation's health care system.
The tax reform eliminated tax penalties for not having insurance. The AMA has also acknowledged that the ACA has problems that need to be fixed, such as gaps in coverage.
Henneke rejected arguments that Congress never meant to repeal the ACA in its entirety when it zeroed out the individual mandate tax penalty in 2017.
Engelhardt, the Trump appointee, primarily grilled attorneys representing California Attorney General Xavier Becerra, a score of other Democratic-led states andthe Democratic House.
The opposed states argue the law is a cavalier attempt to mandate Americans buy health insurance the government deems suitable and necessary.
"It seems like the language used is pretty heavy when it comes to those provisions being interlocking or intertwining", he said. Engelhardt suggested that if the health care law needs to be revised, lawmakers on Capitol Hill should do it, not the courts. This spring, the administration changed its position mid-appeal, with the Justice Department telling the 5th Circuit it now agrees with the district court that the entire law is invalid.
"There's a political solution here that you, various parties are asking this court to roll up its sleeves and get involved in", Engelhardt said.
"Why does Congress want the ... judiciary to become the taxidermist for every legislative big-game accomplishment that Congress achieves?"
With no tax penalty now in effect, the Texas lawsuit argues, the individual mandate is unconstitutional and the entire law must fall without it. O'Connor, the federal judge in Texas, agreed in a December ruling.
"How do we know that some members of Congress didn't say, 'Aha!" California argues that all of the law is separate from the mandate, and Texas argues that none of it is, as the result of what Solicitor General Kyle Hawkins characterized as "an inseverability clause". "The best evidence is the text itself", he said. "That is the beginning and the end of the severability argument". But August Flentje, special counsel to the Justice Department's civil division, advanced an argument the administration only recently has begun to make.
Elrod asked about the possibility of striking down the law only in states where officials joined the lawsuit. He said the legal remedy for those states would involve only the parts of the law that have harmed them.
"Today's job by the court of appeals is to call balls and strikes and constitutionality and leave it to the Congress and to our state leadership to actually address healthcare policy that will restore choices, doctors, decreased costs, improve access to care for the millions of Americans like my clients that have been injured by the Affordable Care Act", he said. "As leading supporters of the legislation recognized, their invalidation would throw our health care system into chaos and would deprive patients of critical benefits that Congress intended them to have".
Congressional Republicans have sought to distance themselves from the lawsuit.
Democrats have warned that nullifying the ACA would impact coverage for millions of individuals with preexisting conditions.
For almost two hours in a New Orleans courtroom, the judges - two Republican appointees and one by Democratic President Jimmy Carter - voiced skepticism about arguments that the individual mandate is now essentially just a toothless government suggestion.
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