Efforts Underway to Defend the ACA

State Attorney Generals across the U.S. will be working through the Christmas holiday preparing expedited briefs supporting the Affordable Care Act (ACA).

The U.S. District Court judge in Texas that issued a controversial December 14 ruling declaring the ACA unconstitutional issued a follow-up order on December 18 requiring both sides to submit briefs explaining why his original order should be stayed or move forward.

The plaintiffs in the case (those who oppose the ACA) had until December 21 to submit their briefs, and then the defendants (18 Democratic AGs in favor of the ACA) have until December 26 to respond.

Massachusetts Attorney General Maura Healey is one of the 18 AGs whose December 17 brief asked the court to issue an order saying that regardless of the original order ruling the ACA unconstitutional, all states and individuals have to abide by the ACA until the inevitable court appeals are played out.

“An order clarifying the import of the Court’s ruling would help quell concerns about the effect of the December 14 ruling while this litigation continues and provide peace of mind to millions of Americans relying on the ACA for health insurance in 2019,” the defendants wrote.

Since Judge Reed O’Connor’s ACA ruling, legal experts on both sides of the issue have weighed in and essentially agree that the case will most likely eventually end up in the Fifth U.S. Circuit Court of Appeals.

MHA President & CEO Steve Walsh last week offered “strong support” for the efforts by AG Healey and the state’s Congressional delegation to defend the ACA. He raised concerns with the serious consequences on health coverage for Massachusetts residents, stating, “If the ruling were to stand, it would turn back the clock and cause immeasurable harm here in Massachusetts.” 

Beyond its effect on health coverage, the ACA has also been instrumental in payment and delivery reforms. Walsh said, “The ACA has been a catalyst for profound innovations that have improved how healthcare is paid for and delivered for all patients, including those in the Medicare and Medicaid programs. Our hospitals and the thousands of Massachusetts healthcare employees are on the front lines of providing some of the best care in the world. They are hard at work to improve care coordination and delivery, while simultaneously responding to an opioid crisis, increased prescription drug prices, a behavioral health system in need of repair, and an aging patient population – all with limited financial resources. If we lose the support and protections provided by the ACA, progress on all of these efforts will be seriously challenged.”

Hospital executives in states that are attempting to expand their Medicaid program say the Texas court ruling – even if stayed pending appeal – could have a chilling effect on their efforts. As one executive stated in a conference call in which MHA participated last week, Republican legislators opposed to expansion efforts can use the court decision as an argument to take a “wait-and-see” stance while putting expansion efforts on the back burner.