State Attorney General Offers Guidance on Health Insurance

In the wake of the Dec. 14 decision by a federal court judge in Texas on the Affordable Care Act, the Office of Attorney General Josh Shapiro is offering guidance on what the ruling holds, what the impact is for Pennsylvanians, and what may happen next in this important case.

Q: What did the Court’s ruling say?

A: In a case filed by plaintiffs, Texas attorney general and 19 other Republican attorneys general and other officials, U.S. District Court Judge Reed O’Connor ruled that the entire Affordable Care Act (ACA) is invalid and should be struck down.

Judge O’Connor’s decision granted summary judgment to the lawsuit’s plaintiffs – but it did not grant an injunction, as the plaintiffs had asked for.

As part of a tax overhaul a year ago, congressional Republicans had pushed through a change in which the ACA penalty to individuals for not having health insurance will be eliminated, starting in January. The Texas lawsuit argued that, with the penalty gone, the individual mandate could no longer be characterized as a tax, so it was unconstitutional.

In his opinion, Judge O’Connor ruled that the ACA’s individual mandate is unconstitutional, saying it “can no longer be fairly read as an exercise of Congress’ tax power,” and then ruled that the remainder of the ACA could not be severed from the individual mandate.

Q: Why can Pennsylvania continue to enforce the ACA’s protections, since a court struck down the law?

A: The Office of Attorney General Shapiro made the decision not to intervene in this lawsuit because it did not want Pennsylvania to be bound by this expected unfavorable court ruling in a way that would jeopardize coverage for Pennsylvanians for pre-existing conditions.

Ordinarily, a judge hearing a lawsuit only has the power to issue rulings that are binding on the parties to the suit. This case is no exception. Here, the parties to the lawsuit are plaintiff States that sued to invalidate the ACA, the federal government, the States that intervened to defend the law, and two individuals. Pennsylvania is not a party to the suit.

When a federal law is challenged in court, an order that binds the federal government usually prevents the law from being enforced anywhere, because the federal government is primarily responsible for carrying out federal law. However, this situation is different from other cases.

The states have the legal authority to enforce many of the key provisions of the ACA, including, most importantly, protections for people with preexisting conditions.

Pennsylvania has exercised its right to enforce these provisions and requires insurers in the Commonwealth to comply with these legal requirements. Because Pennsylvania is not a party to this lawsuit, the judge’s decision cannot prevent Pennsylvania from continuing to enforce these protections.

Q: What does this mean for Pennsylvanians’ coverage under the Affordable Care Act right now?

A: Well in advance of this decision, Attorney General Shapiro and his legal team worked with Pa. Gov. Tom Wolf and the Pennsylvania Insurance Department to ensure that the ACA’s vital protections would continue to be enforced in the Commonwealth, no matter what the judge decided.

The Trump Administration has also confirmed this ruling will have no immediate effect on enforcement of the Affordable Care Act. The White House issued a statement on Dec. 14 saying: “We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place.”

The federal government’s website for the ACA, http://www.healthcare.gov, had an alert on its site as of Dec. 15, stating: “Court’s decision does not affect this season’s open enrollment.”

In addition, the administrator for the Centers for Medicare and Medicaid Services stated on social media Dec. 14: “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”

The deadline to sign up for ACA coverage during open enrollment was midnight Dec. 15, 2018. Signups for open enrollment are not affected by this ruling, so Pennsylvanians who enrolled before that deadline are covered.

Q: What will happen next in the fight to defend and preserve the Affordable Care Act?

A: Gov. Wolf and Attorney General Shapiro will continue enforcing the ACA’s protections in Pennsylvania. If the federal government tries to prevent that from happening, or otherwise denies Pennsylvanians any of their legal rights under the ACA, Pennsylvania fully intends to take legal action to stop them.