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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.

Confirmed Cases: 36287

Reported Deaths: 1249
CountyConfirmedDeaths
Hinds299254
DeSoto195920
Madison148439
Jones122449
Harrison117716
Rankin112619
Neshoba104677
Forrest103843
Lauderdale96681
Scott82415
Jackson79819
Washington73713
Copiah67016
Leake63420
Lee62822
Oktibbeha61928
Grenada6049
Warren60021
Holmes59541
Lamar5837
Wayne56519
Yazoo5607
Lowndes54817
Leflore53456
Lincoln53335
Lafayette5064
Pike50520
Sunflower5048
Monroe46135
Panola4546
Covington4465
Simpson4433
Bolivar41218
Tate39213
Attala38624
Newton37610
Adams35820
Pontotoc3556
Marion34512
Claiborne30811
Pearl River30332
Winston30111
Chickasaw30019
Marshall2923
Jasper2816
Noxubee2799
Walthall2708
Clay26111
Union25412
Smith25212
Coahoma2306
Clarke22325
Lawrence2132
Yalobusha2089
Tallahatchie1954
Kemper18414
Carroll18211
Montgomery1793
Calhoun1705
Humphreys16910
Hancock14813
Itawamba1478
Tippah14611
Webster13411
Jefferson1283
Prentiss1274
Jefferson Davis1254
Tunica1253
George1233
Greene11610
Amite1123
Alcorn1072
Tishomingo1061
Quitman1011
Wilkinson989
Perry914
Stone772
Choctaw764
Franklin542
Sharkey480
Benton470
Issaquena101
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 49892

Reported Deaths: 1077
CountyConfirmedDeaths
Jefferson6746170
Mobile4904140
Montgomery4547112
Tuscaloosa269053
Madison22689
Marshall198011
Shelby169125
Lee159637
Morgan13385
Baldwin127711
Walker107532
Elmore106721
Etowah101114
Dallas10029
DeKalb9677
Franklin93816
Autauga69815
Russell6860
Unassigned67928
Chambers67730
Butler65229
Limestone6393
Tallapoosa63069
Cullman6156
Houston6077
Lauderdale5776
St. Clair5443
Calhoun5155
Colbert5096
Escambia4888
Lowndes48422
Pike4795
Jackson4352
Coffee4284
Covington41612
Talladega4017
Barbour3992
Dale3951
Bullock37810
Hale35423
Marengo35411
Chilton3312
Blount3201
Clarke3176
Wilcox3038
Winston2995
Sumter29213
Marion29014
Pickens2746
Randolph2639
Monroe2603
Perry2502
Conecuh2318
Bibb2241
Macon2199
Choctaw21712
Greene1989
Henry1553
Washington1488
Lawrence1360
Crenshaw1323
Cherokee1247
Geneva980
Lamar891
Clay852
Fayette851
Coosa661
Cleburne451
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