AAFP Opposes ACA Ruling, Sees 'Profoundly Negative' Impact

Millions Could Lose Insurance Access If Decision Stands

December 18, 2018 12:03 pm News Staff – The AAFP is voicing strong disagreement with a Dec. 14 court decision that could cripple the Patient Protection and Affordable Care Act (ACA) and undo its investments in primary care.

U.S. District Judge Reed O'Connor -- presiding over Texas et al. v. United States et al., a lawsuit brought by 20 state attorneys general seeking to strike down the ACA -- ruled in favor of the plaintiffs. Other states unsuccessfully argued to defend the law.

The ACA, O'Connor said, became unconstitutional once Congress eliminated the tax penalty imposed on people who do not obtain health insurance -- the law's "individual mandate."

In a statement issued Dec. 15,(2 page PDF) AAFP President John Cullen, M.D., of Valdez, Alaska, warned of the "profoundly negative impact" on patients if the ruling were to survive its inevitable appeal.

"If this decision stands, millions of patients are at serious risk of losing the protection of affordable, meaningful health insurance," Cullen said. "Meaningful, affordable health insurance is paramount for all Americans, particularly the more than 52 million people who have pre-existing conditions such as cancer, asthma, diabetes, high blood pressure and other life-threatening or serious chronic diseases."

At stake is much more than the marketplace plans that people think of when they hear "Obamacare." If the ruling stands, the nation's health care system will be set back years as

almost 30 million Americans lose their health insurance;
the tax structure that funds Medicare is radically altered;
the so-called Medicare doughnut hole is restored, dramatically increasing prescription drug costs for seniors;
protections for nursing mothers at work are ended;
enrollment in Medicaid and the Children's Health Insurance Program (CHIP) shrinks by some 15 million people, creating a particular strain on low-income patients; and
privately insured Americans lose annual or lifetime cost limits, coverage of their children through age 26 and required coverage of preventive services without cost sharing.

Cullen's statement echoes a staunch amicus (friend-of-the-court) brief that the AAFP, along with the American Medical Association and three other specialty organizations, filed with the court in June after the U.S. Department of Justice announced that it would not defend the ACA in Texas v. United States.

Cullen reiterated the Academy's support of key ACA components that are under threat from the ruling.

"We support the current law's provisions that establish 10 essential benefits -- such as lab tests, procedures and prescriptions -- which all patients need to prevent health problems and to monitor or treat pre-existing health conditions," he said.

The ruling's potential harms extend to the Teaching Health Center Graduate Medical Education (THCGME) program, which the ACA established. The AAFP views the program as crucial to addressing the shortage of family physicians. Without congressional reauthorization, the program's funding will expire on Oct. 1, 2019.

According to HHS, O'Connor's ruling won't have an immediate effect on the ACA.

The agency said in a Dec. 17 statement(www.hhs.gov) that the court's ruling was "not an injunction that halts the enforcement of the law and not a final judgment" and said the agency would "continue administering and enforcing all aspects of the ACA."

The administration, HHS' statement added, "stands ready to work with Congress on policy solutions that will deliver more insurance choices, better health care and lower costs while continuing to protect individuals with pre-existing conditions."

Meanwhile, Friday's decision addressed just one of the five claims made by the lawsuit's plaintiffs. On Dec. 16, O'Connor issued a scheduling order asking the parties to confer by Dec. 21 to set a timetable for resolving the remaining four claims by Jan. 4, 2019. What follows will affect any appeal filed with the Fifth Circuit Court of Appeals.

The Academy is weighing whether to file an amicus brief to accompany an appeal to this or other rulings in the lawsuit.