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Federal Appeals Court Strikes Down ACA Mandate


An appeals court in New Orleans has struck down the individual mandate, a key part of the Affordable Care Act. But the ruling stopped short of saying that the whole law, known as Obamacare, is invalid. This case is very likely on its way to the Supreme Court, and let's talk about it with NPR health policy reporter Selena Simmons-Duffin. Good morning, Selena.


GREENE: OK, so remind us exactly what this case is that we're talking about.

SIMMONS-DUFFIN: So it's known as Texas v. Azar. If you think back to 2017 when Republicans in Congress had tried to repeal and replace Obamacare again and again, they failed to do that. But then in the tax bill they passed in December, they made the penalty for not having insurance zero dollars. That's the penalty associated with the individual mandate. So the Supreme Court earlier had said that the ACA was constitutional because Congress has the power to tax.

So in this case, the argument goes, a zero-dollar penalty is not a tax, so the mandate is unconstitutional. And because it can't be broken off from the rest of the law, the whole law is unconstitutional. A lower court agreed with that whole argument, but this court - this ruling that just came out found that the so-called individual mandate is now unconstitutional. But on the question of whether it can be broken off from the rest of the law, they sent that back to the lower court for further analysis.

GREENE: OK, and that's where we think this could end up in the Supreme Court eventually. So this step - this decision comes out last night. Has there been reaction so far?

SIMMONS-DUFFIN: Yes. Trump released a statement last night. He called the decision a win and said it, quote, "confirms what I have said all along - that the individual mandate, by far the worst element of Obamacare, is unconstitutional." He also emphasized that this decision will not alter the current health care system in the immediate term, and he mentioned protecting people with preexisting conditions. And that kind of reminds you that this is a bit of a tricky situation for the administration. They are not defending the ACA in court, which is quite unusual since it's a federal law. And many of the provisions in the ACA are popular. The threat from the attempted repeal in 2017 is credited with helping Democrats win the House of Representatives in 2018. And it also brings into relief that Trump does not have a plan to replace the ACA if the law were ultimately struck down.

Some other reactions and statements - Democrats railed on the ruling as heartless and poorly reasoned. Conservative groups were generally pleased and said it proves the ACA was on shaky legal ground all along. And we'll have to see how the public reacts to this news.

GREENE: Well, I mean, speaking about the public - if you're someone who's thinking about your coverage and you're hearing this news about this decision, I mean, what could the impact be for you?

SIMMONS-DUFFIN: Well, it might make people nervous. But the big take-home message is that no one's coverage will be affected by this ruling in the immediate term. This is probably of particular concern for the 20 million people who got their health coverage because of this law, whether it's in the exchanges like or Medicaid expansion. But the stakes go beyond those people. Much of the country's health care system was transformed by this law. Essential benefits, calorie counts on menus - the list is very long, so the stakes are really high.

GREENE: OK, and just remind us what exactly happens next with this case.

SIMMONS-DUFFIN: Well, the California attorney general, who's on the defending side of this case, has said last night they will ask the Supreme Court to hear the case. The Supreme Court will have to decide whether or not to do that. It does seem unlikely that that decision would come before the election next year, so it means that this uncertainty will be hanging over the election all of next year.

GREENE: On an issue that is sure to be very much part of the conversation as we head to an election year. NPR health policy reporter Selena Simmons-Duffin - thanks so much, Selena.

SIMMONS-DUFFIN: Thank you. Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.