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: 501652

Reported Deaths: 10024
CountyCasesDeaths
Harrison34353540
DeSoto32162408
Hinds31977631
Jackson24508383
Rankin22015390
Lee15596235
Madison14597280
Jones13867243
Forrest13461252
Lauderdale11998317
Lowndes11065188
Lamar10522136
Pearl River9547237
Lafayette8557140
Hancock7740127
Washington7443160
Oktibbeha7147133
Monroe6787178
Warren6706176
Pontotoc6677104
Neshoba6642206
Panola6542131
Marshall6476135
Bolivar6323150
Union605794
Pike5824152
Alcorn5676102
Lincoln5439135
George497479
Scott473098
Tippah470381
Prentiss469182
Leflore4663144
Itawamba4640105
Adams4592119
Tate4592111
Copiah448792
Simpson4448116
Yazoo444887
Wayne440072
Covington429094
Sunflower4240105
Marion4232108
Coahoma4168107
Leake408688
Newton381779
Grenada3711108
Stone360664
Tishomingo360092
Attala331789
Jasper330165
Winston314691
Clay308977
Chickasaw301067
Clarke292594
Calhoun279447
Holmes267987
Smith264150
Yalobusha234547
Tallahatchie228251
Greene219449
Walthall218764
Lawrence213140
Perry205956
Amite205256
Webster203046
Noxubee186840
Montgomery179657
Jefferson Davis172243
Carroll169338
Tunica160039
Benton149239
Kemper141941
Choctaw133326
Claiborne132837
Humphreys129638
Franklin120328
Quitman106528
Wilkinson105139
Jefferson94734
Sharkey64220
Issaquena1937
Unassigned00

Alabama Coronavirus Cases

Cases: 820312

Reported Deaths: 15407
CountyCasesDeaths
Jefferson1148731924
Mobile726221339
Madison52362697
Shelby37640350
Baldwin37266552
Tuscaloosa35120612
Montgomery34123740
Lee23540246
Calhoun22236488
Morgan20958378
Etowah19838500
Marshall18381304
Houston17394412
St. Clair16078339
Cullman15468293
Limestone15354199
Elmore15271286
Lauderdale14323295
Talladega13851283
DeKalb12664261
Walker11221370
Blount10207176
Autauga10048148
Jackson9877184
Coffee9211191
Dale8904185
Colbert8877201
Tallapoosa7093198
Escambia6778134
Covington6715183
Chilton6648162
Russell637559
Franklin5969105
Chambers5612142
Marion5010127
Dallas4979200
Pike4796106
Clarke475884
Geneva4575127
Winston4522103
Lawrence4327117
Bibb425386
Barbour357876
Marengo338390
Monroe331664
Randolph329864
Butler326796
Pickens316584
Henry312866
Hale311688
Cherokee302960
Fayette294180
Washington251651
Cleburne247760
Crenshaw245375
Clay243368
Macon234863
Lamar224847
Conecuh186353
Coosa180340
Lowndes175464
Wilcox168939
Bullock151744
Perry138940
Sumter133238
Greene126744
Choctaw88527
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