A federal appeals court today struck down the ACA individual mandate — that is, the Affordable Care Act’s requirement that people have health insurance — calling the provision unconstitutional. The court’s decision hinged on Congress’s 2017 tax bill, which reduced the tax penalty for being uninsured to zero dollars.
Judge Jennifer Walker Elrod’s opinion declared the ACA individual mandate unconstitutional “because it can no longer be read as a tax, and there is no other constitutional provision that justifies this exercise of congressional power.”
What’s Next for the ACA?
Strictly speaking, the appellate court’s decision to get rid of a zero-dollar tax is inconsequential—but the case isn’t over yet. In its 2 to 1 decision, the appellate panel punted further questions about the validity of the Affordable Care Act. It sent the case back to the lower court—which one year ago said the entire law was unconstitutional—for further analysis.
Law and policy experts expect this case to eventually end up in front of the U.S. Supreme Court, which has twice in the past decade declared the ACA constitutional. If a more conservative court agrees with the appeals court, however, it could throw our health care system into chaos.
As noted by Julie Rovener at Kaiser Health News:
Hanging in the balance is not only health coverage for the roughly 20 million Americans directly served by the ACA, but also hundreds of millions more whose health care and coverage have been affected by the thousands of changes to the health care system enacted in the law. Those include provisions as wide-ranging as changes in Medicare drug copayments, requirements for calorie counts on menus, a pathway for approval of generic copies of expensive biologic drugs and, perhaps most important politically, protections for people with preexisting conditions.
The next big decision on the validity of Obamacare may not come down until after the 2020 election. Meanwhile, the Affordable Care Act remains in effect. As far as penalties go, states may continue to enact their own insurance mandates, backed up by state tax penalties.
For a roundup of news stories about today’s appellate court decision, see the KHN Morning Briefing.
Open enrollment for 2020 health insurance ended early this morning in most states; in others, it’s not too late to sign up. Learn more about the Affordable Care Act in your state by visiting our Obamacare learning center.