HARTFORD, CT —A federal appeals court sided Wednesday with Republican opponents of the Affordable Care Act, ruling that the individual mandate — zeroed out by Congress two years ago – is unconstitutional. But it didn’t throw out the entire law.
Two years ago, Congress removed the individual mandate through the Tax Cuts and Jobs Act and that’s when Republican attorneys general from Texas and other states stepped in to challenge the Affordable Care Act in federal court.
“The individual mandate is unconstitutional because it can no longer be read as a tax, and there is no other constitutional provision that justifies this exercise of congressional power,” U.S. Circuit Judge Jennifer Elrod wrote for the majority.
The case is now being sent back to U.S. District Judge Reed O’Connor in Texas for further analysis to determine if the entire ACA should fall too if the individual mandate is no longer valid.
Patricia Baker, president and CEO of the Connecticut Health Foundation, said the most important thing for everyone to remember at the moment is that “nothing changes.”
“The open enrollment period to buy health insurance for 2020 through Access Health CT, the state’s health insurance exchange, remains in effect, and federal financial aid is still available to help people pay for their coverage. The existing rules about coverage still apply,” Baker said.
Enrollment is still open through Jan. 15.
“While the ruling has no immediate effect, the way this case is ultimately resolved could be consequential,” Baker added. “ If the U.S. Supreme Court eventually overturns the Affordable Care Act, it would have significant effects on Connecticut residents.”
A 2017 report on the impact of the Affordable Care Act in Connecticut identified effects on nearly everyone in the state.
The report commissioned by the Connecticut Health Foundation and produced by the Urban Institute found more than 160,000 state residents – 5.4 percent of the population under 65 – had health care coverage because of the health law and would likely be uninsured without it.
The report also found 1.9 million people with employer-sponsored insurance gained zero-copay preventive care, protection from catastrophic costs because of the law’s ban on lifetime coverage limits, and immediate access to health insurance if they lose job-based coverage. The law also benefited residents covered by Medicare because it helped those individuals gain access to annual physicals, mammograms, colonoscopies, and other preventive services with no out-of-pocket charges, as well as significantly more coverage for prescription drug costs by reducing the “donut hole.”
Connecticut is in a better position than most states because individuals with state-regulated insurance wouldn’t lose coverage based on pre-existing conditions, but Connecticut doesn’t have the money to subsidize premiums or fund Medicaid expansion without the help of the federal government.
In Connecticut there are 2.21 million privately-insured residents. Of those, about 1.85 million get their insurance from large group plans, 131,000 have individual plans, and 235,000 people are covered under small group plans. The Insurance Department doesn’t regulate the plans of 1.85 million people in the large group market, where the terms of employee benefits are set by employers.
So of those 2.21 million privately-insured residents, the 366,000 with individual plans or those who are covered under small group plans are protected from losing coverage for pre-existing conditions, but the cost of that coverage could increase dramatically without protections of the ACA.
Several months ago, U.S. Sen. Chris Murphy urged his Republican colleagues to start thinking about what would happen if the federal appeals court upholds the lower court ruling.
“What are the Republicans in the Senate going to do if Texas v. United States is decided for the Republican plaintiffs?” Murphy asked in September.
On Wednesday, Murphy tweeted: “Republicans own this.They owe Americans an explanation.”