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Department of Justice says entire ACA should be thrown out

The federal opinion is submitted as Democrats say they will release legislation to protect pre-existing conditions.

Susan Morse, Senior Editor

The U.S. Department of Justice has agreed with a Texas district court judge in releasing an opinion that the Affordable Care Act should be struck down.

This is a reversal of the DOJ's earlier opinion in the district court in which the DOJ previously defended all of the ACA other than the individual mandate, including pre-existing condition provisions.

The DOJ's opinion was issued as the Fifth Circuit Court of Appeals considers the constitutionality of the ACA, in Texas vs. United States. The DOJ supports the decision of the court of the Northern District of Texas invalidating the entirety of the Affordable Care Act, now that the individual mandate is gone.

"Because the United States is not urging that any portion of the district court's judgment be reversed, the government intends to file a brief on the appellees' schedule," the DOJ said in a letter filed Monday evening with the Fifth Circuit, U.S. Court of Appeals.

House Democrats are ready to unveil new healthcare legislation aimed at protecting pre-existing conditions, House Speaker Nancy Pelosi said yesterday.

WHY THIS MATTERS

Insurers and providers have both come against past efforts to end the ACA.

Providers see more insured patients under the ACA.

Insurers are finally seeing stabilization in the market and said the court case puts the coverage of millions at risk.

TREND

The lawsuit was brought byTexas and the 19 other Republican-led states, based on the end of the individual mandate. In February, U.S. District Court Judge Reed O'Connor agreed that the federal law cannot stand without the individual mandate because if there is no penalty for not signing up for coverage, then the rest of the law is unconstitutional.

On Monday, the Centers for Medicare and Medicaid Services released its 2019 open enrollment report, showing a decline of around 300,000 plan selections for the year. The number of plan selections was about 11.4 million, representing a 1.5 percent drop from the prior year, the first decline since the exchanges began operations in 2014, CMS said.

Lower demand for exchange coverage could be attributed to a strong economy and growing employment that likely increased the number of people with employer-sponsored coverage, CMS said. Another factor was the roughly 100,000 people who were enrolled in the exchange in Virginia at the end of 2018 and reported incomes that would make them eligible for the new Virginia Medicaid expansion in 2019.

The percent of young adults aged 18-34 who selected a plan through HealthCare.gov remained unchanged from the prior year at 26 percent.

The report also shows the average monthly premiums for plans purchased through HealthCare.gov before taking advantage of advanced payments of the premium tax credits available to eligible consumers was $612, down from $621 for the previous open enrollment period. After these advanced payments were applied, the average premium was $87 compared to $89 for the prior year.

CMS has issued guidance extending for one additional year, the non-enforcement policy to allow issuers to continue certain health plans -- often referred to as "grandmothered" plans -- which do not meet all the many mandates and restrictions in ACA. These plans can be more affordable, CMS said.

ON THE RECORD

"We said before that the district court's decision was misguided and wrong," said Matt Eyles, president and CEO of AHIP. "So, too, is the government's reversal to now support it. This harmful position puts coverage at risk for more than 100 million Americans that rely on it."

CMS Administrator Seema Verma. "By extending the grandmothered plan policy, we are following through on our commitment to protect those left behind by Obamacare."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

 

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