Texas Judge Weighing Arguments in Case Seeking to Halt ACA

Alicia Ault

September 07, 2018

After hearing arguments from both sides, a federal judge in Texas indicated that he would rule soon on whether to block enforcement of the Affordable Care Act (ACA) until a full trial can be held on a bid to overturn the law.

Twenty states are seeking to invalidate the ACA, claiming that it is unconstitutional, especially in light of Congress having removed an essential part of the law — the penalty on individuals who did not purchase health insurance. Attorneys representing the 20 plaintiff states and lawyers for a group of 17 Democratic state attorneys general intervening on behalf of the ACA went before US District Court Judge Reed O'Connor on September 5 in Fort Worth, Texas.

The 20 states were aiming to secure an injunction to put the ACA on hold until O'Connor decides whether the law is valid. They want an immediate halt to the law, although the individual mandate penalty does not cease to exist until January 1, 2019.

O'Connor said after the 3-hour hearing that he would get something out quickly, according to Politico. The judge could possibly skip ruling on the injunction and instead issue a full ruling on the lawsuit by the attorneys general filed in February.

The federal government, through the Department of Justice (DOJ), is a party to the case. In a filing to the court in June, it said that it doesn't believe the entire law should be dismantled. Instead, the DOJ said it would not defend key parts, including one that requires insurance companies to sell to people with preexisting conditions.

But the government does not support an injunction. At the Texas hearing, DOJ attorney Brett Schumate asked O'Connor to postpone any ruling until after open enrollment for 2019 — which begins November 1 — is over, citing a potential for disruption in the insurance market.

"The last thing we want is for chaos in the market," said Schumate, according to Politico. "We certainly don't want people to lose their health insurance going into next year," he said, according to the New York Times.

Most reports on the hearing noted that O'Connor, a George W. Bush appointee, pressed all sides but seemed most sympathetic to the arguments from the 20 states seeking to overturn the law.

The case will likely be appealed, but advocates have still raised concerns about the possible dismantling of protections for people with preexisting conditions.

Physicians, Advocates Aim to Keep ACA

The American Medical Association, along with the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry, filed a joint friend of the court brief supporting the Democratic states. They said that overturning the ACA "would have a devastating impact on doctors, patients, and the American health care system as a whole."

Also filing a joint amicus brief: the American Cancer Society, the American Cancer Society Cancer Action Network, the American Diabetes Association, the American Heart Association, the American Lung Association, and the National Multiple Sclerosis Society.

In a statement in June, the organizations said, "Before the ACA more than half of heart patients reported difficulty paying for their care and of those patients more than 40 percent said they had delayed care or had not filled prescriptions." They stated that uninsured patients with diabetes were six times as likely to forgo necessary medical care than those with coverage and that uinsured patients were less likely to be screened for cancer and more likely to be diagnosed with later-stage disease.

If the preexisting conditions protection is overturned, it will likely affect a small number of Americans, William G. Stuart, an insurance consultant in Manchester, New Hampshire, told Medscape Medical News in an earlier story. People with employer-sponsored insurance would be protected through the Health Insurance Portability and Accountability Act. Medicare and Medicaid recipients would also have protection, but new employees, workers at companies that self-insure, and people in the individual insurance market, along with Americans enrolled in the ACA exchanges, could be subject to exclusions, he said.

AARP and the AARP Foundation also filed an amicus brief in support of the ACA in June. They noted one aspect of particular concern to older Americans: that doing away with the law would restore the "donut hole" to Medicare drug coverage. As a result, "seniors would be forced to pay even more out-of-pocket for their prescription drugs," said AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond in a statement at the time.

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