This Thursday, Feb. 9, 2017 photo shows the website, where people can buy health insurance, displayed on a laptop computer screen in Washington. (AP Photo/Andrew Harnik)

5 ways nixing the Affordable Care Act could upend the entire health system

Millions could lose coverage directly

Julie Rovner
December 22, 2018 10:00AM (UTC)

This article originally appeared on Kaiser Health News.

If Friday night’s district court ruling that the Affordable Care Act is unconstitutional were to be upheld, far more than the law’s most high-profile provisions would be at stake.

In fact, canceling the law in full — as Judge Reed O’Connor in Fort Worth, Texas, ordered in his 55-page decision — could thrust the entire health care system into chaos.


“To erase a law that is so interwoven into the health care system blows up every part of it,” said Sara Rosenbaum, a health law professor at the George Washington University School of Public Health. “In law they have names for these — they are called super statutes,” she said. “And [the ACA] is a super statute. It has changed everything about how we get health care.” That concept was developed by Abbe Gluck, a professor at Yale Law School.

The decision is a long way from implementation. O’Connor still must rule on several other aspects of the suit brought by 18 Republican attorneys general and two GOP governors. And a group of state Democratic attorneys general has promised to appeal O’Connor’s decision, which would send it to the 5th Circuit Court of Appeals and, possibly, the U.S. Supreme Court. The high court has rejected two previous efforts, in 2012 and 2015, to find the law unconstitutional.

Meanwhile, here are five ways that eliminating the ACA could upend health care for many, if not most, Americans:


1. Millions could lose coverage directly

More than 20 million Americans who previously were uninsured gained coverage from 2010 to 2017. Some of that was due to an improving economy, but many also gained the ability to buy their own coverage through the law’s federal subsidies to defray the cost of insurance. Other provisions of the Affordable Care Act played a significant role, including its ban on restrictions for people with preexisting medical conditions, expansion of the Medicaid program to more low-income adults and allowing adult children to stay on their parents’ health plans until reaching age 26.

If the law were reversed, federal funding for Medicaid and individual insurance subsidies would stop, and insurers could once again refuse coverage to people with health problems or charge them more.


Julie Rovner

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