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WASHINGTON -- The decision by a federal judge in Texas to strike down the Patient Protection and Affordable Care Act, imperiling the insurance coverage of millions of Americans, has turned the health care debate into a pressing issue for Congress.

After Democrats campaigned vigorously on a pledge to protect patients with pre-existing medical conditions -- a promise that has helped return them to the House majority they lost in 2010 -- the party vowed to move swiftly to defend the law and to safeguard its protections.

Saturday was the open-enrollment deadline for residents of most states to obtain coverage under the health law for 2019.

The Friday ruling, if it stands, not only does away with coverage protections for people with pre-existing health conditions, but it also strikes down the guarantee of coverage for what the law deems "essential health benefits." These include emergency services, maternity and newborn care, mental health and substance abuse treatment, prescription drugs and pediatric care.

But the ruling is so sweeping that many legal analysts believe it is likely to be overturned. The Supreme Court, in a 5-4 decision, has already upheld the Affordable Care Act's legality. The political outcry from the Texas decision, though, is not likely to diminish anytime soon.

"This is a five-alarm fire," said Sen. Chris Murphy, D-Conn. "Republicans just blew up our health care system."

Republicans were muted in their response, but incoming House Minority Leader Kevin McCarthy of California appealed to Democrats to help in negotiating a successor to what he called "an unconstitutional law."

"President [Donald] Trump has made clear he wants a solution, and I am committed to working with my colleagues on both sides of the aisle to make sure America's health care system works for all Americans," he said in a statement Saturday.

The Democrats' first step will be in the courts; aides to current House Minority Leader Nancy Pelosi of California said Saturday that House Democrats would move quickly to notify the Trump administration that they intend to intervene in the case. A vote on a resolution to do so is expected in the earliest days of the new Congress, when Democrats gain control of the House.

Democrats also intend to convene hearings to spotlight the sweeping effect of the Texas ruling. If upheld on appeal, the decision would threaten the health insurance of an estimated 17 million Americans -- including millions who gained coverage through the law's expansion of Medicaid. Still others could see premiums skyrocket as price protections for pre-existing conditions lapse.

In his ruling Friday, Judge Reed O'Connor of the U.S. District Court in Fort Worth struck down the law on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it. The judge found that the "myriad parts" of the law are all interconnected. Without the mandate, he said, the rest of the law comes crashing down.

"The ruling is a big win for Arkansans," state Attorney General Leslie Rutledge said in a statement Saturday. "Without the individual mandate in place, Obamacare cannot be upheld and is unconstitutional. Now, it is time for Congress to increase options, lower costs and protect those with pre-existing conditions."

The immediate practical effect of the ruling was not clear. While the judge declared that the whole law was invalid -- as Texas and 19 other states, including Arkansas, had asserted -- he did not issue an injunction to stop federal officials from enforcing it, and the effects of the judgment could be delayed pending appeals.

In an email to millions of Americans on Saturday, the Trump administration tried to allay concerns caused by the court decision.

The case is "still moving through the courts," said the message from the federal Centers for Medicare and Medicaid Services. "The marketplaces are still open for business, and we will continue with open enrollment. There will be no impact to enrollees' current coverage or their coverage in a 2019 plan."

But Trump was in a celebratory mood. "It was a big, big victory by a highly respected judge, highly, highly respected in Texas, and on the assumption that the Supreme Court upholds, we will get great, great health care for our people," Trump told reporters Saturday. "We'll have to sit down with the Democrats to do it, but I'm sure they want to do it also."


On Saturday, the ruling came under attack from legal analysts who predicted that higher courts will reject the rationale as an effort to rewrite not just the law but congressional history.

The judge's ruling flouts settled legal doctrine and places key acts of Congress in reverse order, said Yale law professor Abbe Gluck, who filed an amicus brief with other lawyers in the Texas case.

By ignoring that Congress declined to strike down the Affordable Care Act in 2017 when it chose to alter only one portion of the bill, she said, the judge decreed that the 2010 Congress, which first passed the law, has more authority than the same legislative body in 2017.

"It's absolutely ludicrous to hold that we do not know whether the 2017 Congress would have wanted the rest of the ACA to exist without an enforceable mandate, because the 2017 Congress did exactly that when it zeroed out the mandate and left the rest of the ACA standing," Gluck said. "He effectively repealed the entire Affordable Care Act when the 2017 Congress decided not to do so."

Ted Frank, a lawyer at the Competitive Enterprise Institute who is critical of the health care law, called the decision "embarrassingly bad" because "you're twisting yourself into knots" to reach a particular conclusion.

Over the past two years, Frank said, conservative lawyers such as he have complained when district judges did similar intellectual gymnastics to attack Trump administration initiatives. "It's not appropriate in the other direction, either," he said.

Nicholas Bagley, a University of Michigan law professor, predicted "a long slog" while the courts wrestle with O'Connor's decision.

"I think this case is frivolous, and I think the judge's opinion is about as naked a piece of judicial activism as I have ever seen; I don't even think it's close," said Bagley, who supports the Affordable Care Act. "Like any lawsuit, you should take it seriously, but I don't think this is an imminent or mortal threat to the Affordable Care Act."

After struggling for eight years to come up with an alternative to the Affordable Care Act, some Republicans in Congress expressed hope that the judge's decision would be a catalyst for cooperation, which has been virtually nonexistent to date.

"While the ruling will certainly be appealed and will not impact insurance premiums or plans for next year, we have a rare opportunity for truly bipartisan health care reform that protects those with pre-existing conditions," said Rep. Greg Walden, R-Ore., departing chairman of the Energy and Commerce Committee.

Sen. Bill Cassidy, R-La., said the court ruling showed the need for a bill such as one he introduced in 2017 with Sen. Susan Collins, R-Maine. The bill would keep consumer protections from the Affordable Care Act but give states much more discretion over the use of federal funds for health care.

"Obamacare is failing," said Cassidy, who is a medical doctor. "People are going without insurance because they can't afford it. Democrats may be doing the political calculus, saying, 'This is great for us because we want to use the issue in 2020.' But I don't care about the politics. I'm concerned about that family of four in Louisiana who don't get a subsidy, who are paying $40,000 a year for a policy with a $13,000 deductible."

Under the Affordable Care Act, many people of modest means can obtain subsidies covering all of their premiums, so the insurance is essentially free. But for those whose income is too high to qualify for subsidies, the costs remain high -- a problem that the Trump administration and congressional Republicans have seized on.

Encouraging enrollment under the Affordable Care Act has never been a priority for Trump administration officials, and confusion caused by the court decision in Texas could further depress enrollment, which was already lagging behind last year's numbers.

From Nov. 1 to Dec. 8, about 4.1 million people had signed up for coverage through the federal marketplace, with new enrollment in the 39 states that use the federal website down by 20 percent compared with the same period last year.

In all, 11.8 million people in the U.S. signed up for health insurance through the law's marketplaces for 2018. This year's enrollment period has ended in most states; six states and Washington, D.C., have later deadlines.

Information for this article was contributed by Sheryl Gay Stolberg, Robert Pear and Abby Goodnough of The New York Times; and by Devlin Barrett of The Washington Post.

A Section on 12/16/2018

Print Headline: Axing of health law raises urgency in D.C., but experts say ruling unlikely to stand

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  • 23cal
    December 16, 2018 at 6:13 a.m.

    He really believes that 20 million people losing healthcare and rates skyrocketing for another 130 million with preexisting conditions is "great news" because it strikes a blow at the legacy of a man for whom Trump isn't fit to shine his shoes.
    This is truly sick.
    If the ACA is overturned, the Republicans will pay mightily. They better beware of what they hope for. They spent the mid-terms lying about pre-existing conditions for a reason.
    Most likely, this decision will get overturned.
    Come on,Single Payer!

  • RBear
    December 16, 2018 at 6:33 a.m.

    I read some of the comments by right wingers in yesterday's articles and saw how little they really understand about the ACA and the judge's ruling. Most were just Trump shills who have to wait for his tweets to get their talking points for these comments.
    The ACA has done quite a bit for Americans and was stabilizing after all the ruckus caused by Republicans attempting to overturn it. Premiums had stabilized and were coming down in some states even though Trump has tried everything he could to sabotage it. All this while Republicans failed to come up with a reasonable plan to replace it since it was first enacted. In other words, they don't have any plan. They just don't like the fact Obama and Democrats actually came up with a working plan.
    Reading the 55 pages of the opinion and some of the legal analysis, this was really a shoddy opinion that actually doesn't stand much chance of standing on its own. The premise put forth by O'Connor supporting the AGs position was that if one part of the ACA is removed, the entire thing is invalid. That position taken even though O'Connor admitted he hasn't combed through the ACA. He just believes it is unconstitutional without pointing out what parts are.
    SCOTUS has supported the ACA twice already and even with Kavanaugh will probably support it again. But it won't stop Republicans from trying to remove healthcare from millions of Americans without providing a reasonable alternative. Republicans gripe about activist judges except when they find one who rules in their favor. It just shows how hypocritical that party has become thanks to deplorables.

  • skeptic1
    December 16, 2018 at 8:45 a.m.

    Constitutional law is lost on the lefty loons here. The ACA was unconstitutional from the beginning, Roberts bent to pressure from the left and only partially overturned it, this judge is correct on the law. What this will do is force the Dems to work with the GOP to come up with health care that makes sense. I predict the Dems will spend the next two years trying to remove Trump and accomplish nothing.

  • condoleezza
    December 16, 2018 at 9:31 a.m.

    Skeptic. The Rightists have had well over a decade to come up with something and they have failed by every measure. Hope you, or anyone in your family, does not haven any pre-existing conditions. I did, and OCare saved my life. Rightists would have gladly let me die or go bankrupt for mistakenly getting cancer. Silly me.

  • condoleezza
    December 16, 2018 at 9:32 a.m.

    Skeptic. Just curious, but with a moniker like "skeptic," why don't you ever question a president who lies numerous times every day?

  • RBear
    December 16, 2018 at 9:34 a.m.

    ROTFL @ skeptic. Provide details that show the ACA is unconstitutional. Show your work instead of wearing your idiotic tin-foil hat and claiming conspiracy on SCOTUS. Yesterday, you said the ACA was Obama’s ONLY legislative victory which is a big fat lie. Many victories. But when we look at Trump, he can’t even pass an ACA replacement. You may say tax cuts, but Obama got those passed also. Shows how out of touch you are.

  • condoleezza
    December 16, 2018 at 9:48 a.m.

    Skeptic. What do you think about Trump's #1 lie from last night? "President Donald Trump on Saturday angrily cited a story by a right-wing outlet claiming that some 20,000 texts by a former FBI agent and bureau lawyer were intentionally erased by an official of the Justice Department before its inspector general could examine them. But that account has been contradicted by his own administration— the Office of the Inspector General." ;-) There were other lies throughout the day, but this one was just to easy to discredit.

  • skeptic1
    December 16, 2018 at 10:02 a.m.

    condoleezza...I am Skeptic of the false narratives the media spews. I was a life-long Democrat until 2008 when I did my own research into Obama and was horrified that the media wasn't reporting on who he really is. You don't know what or who I question as my comments here are in regard to specific issues. I am not a Republican and I did not vote for Trump, I do like what he has done so far though which is more than Obama and Bush did in their 8 years. I am disgusted at the left's continued cynical Orwellian Double-Speak, the left is developing a 21st century version of fascism by trying to silence any opposing views and using race, class, and gender as political weapons. My question to you is why don't you question the left's bizarre and obsessive Trump derangement syndrome?

  • RBear
    December 16, 2018 at 10:31 a.m.

    And yet “skeptic” is not skeptical of a president who lies constantly, a president who lied twice about the hush payments. Skeptic was a Dixiecrat who could not tolerate an African-American president. So glad we rid the Democratic Party of those Dixiecrats as they were a plague in the party, carrying forward racist and homophobic views as the norm.

  • LRCrookAtty
    December 16, 2018 at 10:45 a.m.

    The ACA has caused prices to triple and deductibles to double for those that had insurance coverage prior to ACA. I am all for a cut-out for pre-existing conditions, but we need to remember that this is not insurance. If my house burns down, and then I call to get home insurance, I will be denied. If I have cancer and then I call to get insurance, this is not insurance. It is a fact that I have been arguing for years. For example, vision insurance is not insurance. It is coverage to pay a portion of your vision exam and frames, that will invariably have to be paid. Insurance, for example on your car, is a premium you pay to cover IF something happens, not WHEN it happens.

    Prior to ACA there were cheap (averages of 50-100 dollars a month) CATASTROPHIC plans, with high deductibles ($10k-$15k), however, now most people that had insurance (actual insurance) prior to ACA had deductibles in the $3500 range (my family). Now, my family has $7500 deductibles. This means that I do NOT have insurance until I pay $7500 out of pocket. I also pay a higher premium (nearly triple to what I paid prior to ACA). Basically (from my wife who is a high level director for CIGNA insurance) she tells me that our premium and those of others that were willing to pay before, as well as, the deductibles, allow others (that do not need insurance, they need someone to pay) to have their bills paid.

    I do not see the purpose of covering people until 26 under their parents' insurance. I also do not see the need for pre-existing condition coverage. The reason is that it was already available. My wife's company would cover your pre-existing condition, if you had not gone 90 days without insurance or you were covered at the time the condition occurred or you were under the age of 12 when the condition occurred. Then if you did not fall into those three areas, local charities would help with the medical bills of those in need (and it did not cost as much as this BS legislation)

    The republicans lost the house because we elected them to REPEAL ObamaCare, not to repeal "AND REPLACE" ObamaCare. We need a legitimate open market and the government needs to get out of the way. Look at the eye surgery that is not covered by any insurance plan at all. It is on the open market and the price has dropped dramatically over the last decade to were any individual that desires to have it performed can do so.