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Posted: Dec 16, 2018 8:37 PM
Updated: Dec 16, 2018 8:59 PM

Late on Friday, a federal district judge in Texas, Reed O'Connor, dropped a bomb on the Affordable Care Act, and indeed on the entire American health care system.

His ruling, in Texas v. U.S., was a victory for the 20 Republican state attorneys general and governors who had brought the case in February, asking the court to block operation of the health care law. They based their attack on the law's requirement that people either buy health insurance or pay a penalty, which opponents of the law have long called an unconstitutional mandate.

In a landmark decision in 2012, the Supreme Court upheld the law by declaring that mandate was actually a tax, which Congress had the authority to impose. But when Congress reduced the tax to zero last year, the plaintiffs argued that now -- without its individual-responsibility enforcement mechanism -- the entire Affordable Care Act was suddenly unconstitutional.

Judge O'Connor agreed. He said further that the law and its mandate could not be separated, and with this key part missing, the whole law should collapse, like a pillar of blocks in the game Jenga.

The scope of Judge O'Connor's judgment is breathtaking. The ACA contains ten titles and hundreds of individual provisions governing every corner of our health care system. The invalidation of the ACA, if upheld on appeal, would affect virtually every American.

Of course, millions of individuals who purchase their insurance directly from insurers or through the marketplaces would lose the ACA's preexisting condition protections. Older Americans and women could again be discriminated against as well.

Millions of individuals and families covered through the ACA's Medicaid expansions would lose coverage — even in states that have recently passed referenda to expand coverage — but other Medicaid beneficiaries would lose benefits conferred by the ACA as well.

Medicare beneficiaries would lose preventive-services coverage and could see the "donut hole" reopen, imposing higher drug costs. Indeed, the order may invalidate current ACA regulations governing Medicare payments, throwing the Medicare program into chaos.

Most Americans, who have coverage through their employer, would lose their right to preventive services and coverage of children to age 26 and see lifetime and annual dollar limits of coverage reappear. ACA reforms to the Indian Health Service or provisions for FDA approval of generic biologic drugs would disappear. Fraud and abuse protections included in the ACA would no longer be effective.

In deciding to wreak this destruction on the American health care system, Judge O'Connor arrogated to himself authority that rightly belongs with Congress. A Republican Congress spent most of 2017 debating to what extent it wanted to repeal the ACA. In the end, it only changed one small provision: reducing the shared responsibility tax to $0.

Judge O'Connor believes that in doing so, Congress pulled a grenade pin, exploding the entire law. But numerous Republicans, both during the debate on the vote on the tax law and since, have made it clear that was not what they did.

Judge O'Connor points to the "findings" from the original ACA itself to claim that the mandate was "essential" to various provisions of the law, but those findings were included to bolster arguments that the mandate was constitutional as a legal requirement and were not intended to make the rest of the law dependent on the mandate.

Republicans in Congress repeatedly tried and failed to repeal the ACA. It is not up to an unelected judge to do it himself.

So, what does Judge O'Connor's judgment mean? He specifically did not enter an order blocking the operation of the law, so it remains in effect. O'Connor only found two individuals had standing to challenge the law, so arguably the ruling only applies to them.

Another judge is considering a case brought by Maryland to uphold the ACA, so we may get dueling judgments. An earlier appellate court decision, involving a number of the states in this case, invalidated the individual mandate but held the entire remainder of the ACA to be valid. Any noncompliance with the law may be challenged in other courts.

California will appeal Judge O'Connor's decision and the Trump administration may appeal parts of it as well. It will likely be reversed on appeal and may never get to the Supreme Court. It is simply the opinion of one district court judge.

But it will surely cause chaos and confusion throughout the health care system, as the federal government's lawyer predicted at oral arguments. No doubt that is what Judge O'Connor wanted.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 350070

Reported Deaths: 7590
CountyCasesDeaths
Hinds24512449
DeSoto23513283
Harrison21172335
Rankin15798293
Jackson15735254
Madison11171227
Lee10903180
Jones9223169
Forrest9027163
Lauderdale8087244
Lamar724890
Lowndes7199152
Lafayette6631125
Washington5661140
Pearl River5357154
Oktibbeha503198
Bolivar5004134
Warren4817128
Panola4812112
Marshall4739106
Pontotoc452473
Hancock440388
Neshoba4401181
Union438979
Monroe4369138
Lincoln4228116
Pike3739114
Leflore3676125
Alcorn355374
Tate354988
Sunflower351094
Adams347490
Scott346677
Yazoo342977
Copiah330869
Simpson327191
Itawamba317281
Coahoma315685
Tippah312869
Prentiss302563
Covington302384
Marion289882
Leake288676
Wayne280945
George277351
Grenada272188
Newton266864
Tishomingo240770
Winston238084
Stone235338
Jasper234748
Attala228674
Chickasaw221460
Holmes202574
Clay201954
Clarke189580
Tallahatchie185642
Calhoun183232
Smith183036
Yalobusha173641
Walthall150449
Lawrence145426
Greene141935
Amite139144
Noxubee137235
Perry136138
Montgomery133944
Carroll127031
Webster124332
Jefferson Davis119834
Tunica116127
Benton107825
Claiborne105931
Kemper104429
Humphreys102333
Franklin88424
Quitman86319
Choctaw83119
Wilkinson79332
Jefferson72228
Sharkey51918
Issaquena1746
Unassigned00

Alabama Coronavirus Cases

Cases: 592417

Reported Deaths: 11542
CountyCasesDeaths
Jefferson861091591
Mobile49771865
Madison37714533
Shelby27501259
Tuscaloosa27344465
Montgomery26343628
Baldwin25860329
Lee17336181
Calhoun15498334
Morgan15225291
Etowah15060370
Marshall13198236
Houston12191293
Elmore10977219
St. Clair10852252
Limestone10816158
Cullman10610206
Lauderdale10305254
DeKalb9594192
Talladega9005188
Walker7840288
Autauga7615114
Jackson7431117
Blount7417139
Colbert6752142
Coffee6443132
Dale5723117
Russell482243
Chilton4810117
Covington4804125
Franklin462781
Tallapoosa4571156
Escambia451083
Chambers3987125
Dallas3751163
Clarke372263
Marion3470107
Pike334079
Lawrence3277100
Winston300773
Bibb292865
Geneva288383
Marengo262967
Barbour253761
Pickens247762
Butler242472
Hale236778
Fayette228165
Henry216545
Monroe204541
Randolph202844
Cherokee200748
Washington186839
Macon171552
Crenshaw170658
Clay167159
Cleburne161845
Lamar151938
Lowndes146255
Wilcox132331
Bullock126542
Conecuh122132
Coosa119529
Perry111228
Sumter110633
Greene99337
Choctaw64425
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Columbus
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Thursday will start off once again in the unseasonably cool 60s. We will top off just a few degrees warmer on out Thursday, in comparison to our Wednesday. Most of the high temperatures will be in the lower 90s.
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