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.

Confirmed Cases: 110592

Reported Deaths: 3171
CountyConfirmedDeaths
Hinds7731171
DeSoto655177
Harrison478481
Jackson429178
Rankin380086
Madison371092
Lee339279
Forrest292777
Jones281682
Washington250697
Lafayette241342
Lauderdale2329130
Lamar212038
Bolivar197775
Oktibbeha194154
Neshoba1795111
Lowndes173662
Panola164736
Leflore158786
Sunflower156749
Warren151854
Monroe143672
Pontotoc143019
Pike135555
Lincoln133954
Copiah133336
Marshall130026
Coahoma122836
Scott122729
Grenada119637
Simpson117648
Yazoo116933
Union113825
Holmes113060
Tate112339
Leake111839
Itawamba108724
Pearl River107456
Adams104042
Prentiss100919
Wayne97921
Alcorn94412
George93217
Marion92642
Covington90825
Tippah84820
Newton84227
Chickasaw81724
Tallahatchie81725
Winston81421
Tishomingo78640
Hancock76527
Attala76325
Clarke70948
Clay66621
Jasper66016
Walthall63427
Calhoun60912
Noxubee59516
Smith57716
Claiborne53016
Montgomery52723
Tunica51817
Lawrence48914
Yalobusha47914
Perry47522
Carroll45812
Greene44717
Stone44614
Amite41513
Quitman4096
Humphreys39916
Jefferson Davis39311
Webster36313
Wilkinson32920
Kemper31615
Benton3004
Sharkey27714
Jefferson26210
Franklin2283
Choctaw2036
Issaquena1063
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 152272

Reported Deaths: 2621
CountyConfirmedDeaths
Jefferson22300372
Mobile14273314
Tuscaloosa9886132
Montgomery9615196
Madison895192
Shelby700260
Lee643066
Baldwin636967
Marshall425348
Calhoun408459
Etowah399149
Morgan393232
Houston362332
DeKalb313326
Elmore308152
St. Clair276742
Limestone268327
Walker264192
Talladega253634
Cullman223923
Lauderdale204340
Autauga198928
Franklin198131
Jackson197914
Russell18993
Colbert188927
Dallas184527
Blount182723
Chilton178731
Escambia170328
Covington164429
Coffee16299
Dale161551
Pike130112
Tallapoosa126986
Chambers126643
Clarke126116
Marion103929
Butler99640
Barbour9819
Marengo96421
Winston88613
Geneva8297
Pickens79317
Randolph79314
Lawrence78830
Bibb78513
Hale73729
Cherokee71414
Clay70312
Lowndes69827
Bullock63417
Henry6286
Monroe6259
Washington62012
Crenshaw58830
Perry5796
Conecuh55413
Wilcox55412
Fayette54012
Macon52819
Cleburne5207
Sumter46421
Lamar4555
Choctaw38612
Greene33316
Coosa1963
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