Obamacare's 'essential benefits' explained

Under Obamacare, all insurance providers have to ensure a minimum level of coverage. CNN Chief Medical Correspondent Dr. Sanjay Gupta reports.

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: 500709

Reported Deaths: 9977
CountyCasesDeaths
Harrison34312538
DeSoto32080403
Hinds31924627
Jackson24482379
Rankin21983390
Lee15530235
Madison14574280
Jones13838242
Forrest13447251
Lauderdale11985316
Lowndes11030188
Lamar10508135
Pearl River9503237
Lafayette8547139
Hancock7728126
Washington7422157
Oktibbeha7142131
Monroe6769176
Warren6682176
Pontotoc6659102
Neshoba6635206
Panola6520131
Marshall6462134
Bolivar6313148
Union602494
Pike5817152
Alcorn5667101
Lincoln5433135
George496779
Scott472698
Tippah469081
Prentiss466881
Leflore4657144
Itawamba4633105
Adams4586119
Tate4584110
Copiah448592
Simpson4445116
Yazoo443987
Wayne439772
Covington428794
Sunflower4237105
Marion4225108
Coahoma4159104
Leake408288
Newton381679
Grenada3706108
Stone359764
Tishomingo359692
Attala331489
Jasper329965
Winston314291
Clay307976
Chickasaw299667
Clarke292494
Calhoun279346
Holmes267887
Smith263850
Yalobusha233747
Tallahatchie227151
Greene219048
Walthall218763
Lawrence212440
Perry205356
Amite205155
Webster202746
Noxubee186640
Montgomery179656
Jefferson Davis171542
Carroll168838
Tunica159439
Benton148738
Kemper141941
Choctaw133426
Claiborne132437
Humphreys129238
Franklin120028
Quitman106428
Wilkinson105139
Jefferson94534
Sharkey64020
Issaquena1937
Unassigned00

Alabama Coronavirus Cases

Cases: 817054

Reported Deaths: 15320
CountyCasesDeaths
Jefferson1145501922
Mobile724601333
Madison52172694
Shelby37533348
Baldwin37192547
Tuscaloosa35044606
Montgomery34067734
Lee23195245
Calhoun22205476
Morgan20754376
Etowah19811497
Marshall18317302
Houston17345411
St. Clair15983339
Cullman15383292
Limestone15298198
Elmore15161284
Lauderdale14225294
Talladega13802276
DeKalb12622260
Walker11162369
Blount10162175
Autauga9954146
Jackson9844182
Coffee9195191
Dale8880185
Colbert8826201
Tallapoosa7071198
Escambia6764130
Covington6699183
Chilton6627161
Russell627959
Franklin5955105
Chambers5567142
Marion4982126
Dallas4936200
Clarke474583
Pike4722105
Geneva4566126
Winston4502103
Lawrence4296117
Bibb424086
Barbour356676
Marengo337789
Monroe331463
Randolph328763
Butler325696
Pickens315682
Henry311965
Hale311088
Cherokee301760
Fayette291879
Washington251351
Cleburne247360
Crenshaw244375
Clay241768
Macon232363
Lamar222047
Conecuh185853
Coosa179739
Lowndes174564
Wilcox167939
Bullock151644
Perry138340
Sumter132738
Greene126644
Choctaw88127
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Clear cool and dry to begin your weekend, but both afternoons should be a little bit above what we expect for this time of year temperature wise. Rain chances begin to return late Sunday night, with at least two chances for storms over the next week, summer could be strong.
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