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: 266598

Reported Deaths: 5852
CountyCasesDeaths
DeSoto17807191
Hinds16967332
Harrison14298204
Rankin11280221
Jackson10976190
Lee9088145
Madison8619169
Jones6782118
Forrest6236124
Lauderdale6128192
Lowndes5564120
Lafayette5229101
Lamar507465
Washington4951125
Bolivar4149109
Oktibbeha409482
Panola388281
Pontotoc378560
Warren3698103
Monroe3693110
Marshall358570
Union357764
Pearl River3508106
Neshoba3499154
Leflore3122109
Lincoln307688
Hancock296362
Sunflower293075
Tate281162
Alcorn273554
Pike271081
Itawamba270063
Scott260849
Yazoo257156
Prentiss254554
Coahoma251555
Copiah250749
Tippah250150
Simpson243872
Leake238467
Marion225973
Grenada224272
Covington222473
Adams215371
Wayne215034
Winston207771
George204839
Newton200046
Attala197464
Tishomingo195661
Chickasaw189644
Jasper182538
Holmes172268
Clay167537
Tallahatchie157535
Stone152925
Clarke148662
Calhoun141822
Smith130726
Yalobusha123835
Walthall115037
Greene114529
Noxubee114126
Montgomery112736
Lawrence107617
Carroll106922
Perry105331
Amite102426
Webster97424
Claiborne89725
Tunica89321
Jefferson Davis88930
Benton86523
Humphreys84824
Kemper81020
Quitman7149
Franklin70717
Choctaw63813
Wilkinson59925
Jefferson57121
Sharkey45717
Issaquena1606
Unassigned00

Alabama Coronavirus Cases

Cases: 443009

Reported Deaths: 6662
CountyCasesDeaths
Jefferson649101007
Mobile31746574
Madison28413217
Tuscaloosa21566275
Montgomery20088332
Shelby19452132
Baldwin17333189
Lee13261107
Morgan12678142
Etowah12141181
Calhoun11555206
Marshall10487123
Houston9031164
Limestone838181
Cullman8296124
Elmore8243110
Lauderdale7946107
DeKalb7900107
St. Clair7876130
Talladega6523112
Walker6050183
Jackson603245
Colbert558194
Blount548586
Autauga540762
Coffee466964
Dale412785
Franklin377550
Russell358415
Chilton346873
Covington340880
Escambia339244
Tallapoosa3163109
Dallas313696
Chambers305470
Clarke303336
Pike265231
Lawrence255855
Marion254661
Winston234742
Bibb222948
Geneva213047
Marengo210531
Pickens200431
Hale186144
Barbour183438
Fayette178829
Butler174860
Cherokee166031
Henry160025
Monroe152621
Randolph146636
Washington142727
Clay130746
Crenshaw124845
Macon122837
Cleburne122125
Lamar120622
Lowndes116836
Wilcox108322
Bullock104628
Perry100518
Conecuh98022
Sumter90627
Greene77923
Coosa64018
Choctaw52124
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