The history of Obamacare

CNN's Cyril Vanier gives a history of the Affordable Care Act following the news that a Texas federal judge struck down the law, citing the individual mandate coverage as unconstitutional.

Posted: Dec 16, 2018 8:01 PM
Updated: Dec 16, 2018 8:15 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: 331863

Reported Deaths: 7494
CountyCasesDeaths
DeSoto22855279
Hinds22625437
Harrison19462326
Rankin14765286
Jackson14233251
Madison10658227
Lee10398178
Jones8713169
Forrest8164157
Lauderdale7528243
Lowndes6761150
Lamar665988
Lafayette6446124
Washington5497139
Bolivar4907134
Pearl River4889149
Oktibbeha476898
Panola4719112
Marshall4648106
Warren4612125
Pontotoc438873
Monroe4243137
Union424379
Neshoba4179180
Lincoln4088115
Hancock402788
Leflore3562125
Pike3511111
Tate348988
Alcorn343174
Sunflower342293
Adams331987
Yazoo330573
Scott330175
Simpson313690
Copiah311467
Itawamba309580
Coahoma308285
Tippah298368
Prentiss292563
Covington280183
Marion278980
Leake277975
Wayne269942
Grenada265688
George259851
Newton256064
Tishomingo235769
Winston235084
Jasper225748
Attala220373
Chickasaw215960
Stone209137
Holmes194974
Clay191554
Tallahatchie181542
Clarke181480
Calhoun177332
Smith175334
Yalobusha169240
Walthall140448
Lawrence137026
Greene134934
Amite131843
Noxubee131135
Perry130838
Montgomery130644
Carroll124531
Webster116732
Jefferson Davis112934
Tunica110827
Benton104425
Claiborne104231
Kemper100329
Humphreys99033
Franklin85923
Quitman83519
Choctaw80919
Wilkinson73232
Jefferson69028
Sharkey51518
Issaquena1696
Unassigned00

Alabama Coronavirus Cases

Cases: 565510

Reported Deaths: 11468
CountyCasesDeaths
Jefferson828061584
Mobile44938853
Madison36534532
Tuscaloosa26589465
Shelby26409255
Montgomery25598623
Baldwin23319324
Lee16691179
Calhoun15030332
Morgan14877288
Etowah14563368
Marshall12723235
Houston11302292
Elmore10576217
St. Clair10449251
Limestone10420158
Cullman10198204
Lauderdale9883253
DeKalb9226191
Talladega8705187
Walker7545286
Autauga7388113
Jackson7216117
Blount7147139
Colbert6522142
Coffee5962131
Dale5224117
Russell463942
Chilton4603117
Covington4502125
Franklin439781
Tallapoosa4343156
Escambia414782
Chambers3813124
Dallas3674163
Clarke361562
Marion3354106
Pike323179
Lawrence3176101
Winston289672
Bibb276165
Geneva267383
Marengo257367
Barbour241860
Pickens238862
Butler233571
Hale230578
Fayette223863
Henry203345
Cherokee192347
Randolph192244
Monroe190241
Washington174539
Macon167252
Crenshaw163457
Clay161859
Cleburne158445
Lamar149138
Lowndes143854
Wilcox128431
Bullock125342
Conecuh117730
Coosa115229
Perry109628
Sumter107532
Greene95935
Choctaw63125
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