A Texas judge on Friday evening struck down the entire Affordable Care Act nationwide. If the ruling is upheld, it will impact far more than the half-million Georgians who have an insurance plan through the health care exchange.
Georgians who’ve never touched the federal health care exchange, including those with employer-sponsored insurance, have coverage for pre-existing conditions that was mandated by the ACA, also known as Obamacare. They have insurance that covers prescriptions, mental health and other “essential” benefits because of the ACA. Parents can insure their children on their own plans until the age of 26 — because the ACA says so.
Federal District Judge Reed O’Connor struck down all that.
It's an open question whether the ruling — which came the evening before Saturday's deadline for Georgians to sign up for next year's ACA plans — will survive appeals. But it sent emotions from fear and rage to confusion, relief and satisfaction pulsing through through the state.
Josh Schiffer, a Midtown lawyer whose daughter has a pre-existing heart condition, is “absolutely terrified.”
Dan McBrayer, who sells insurance in Carrollton to many people who can’t currently afford premiums even under the law, has mixed feelings but said, “I see the problems if we continue like we have.”
State Attorney General Chris Carr, who joined Georgia to the multistate lawsuit, said, "What you're seeing is state attorneys general holding the federal government accountable."
Carr said the suit was worth the risk. “We’re a nation of laws,” he told the AJC on Saturday after the Texas judge found the law unconstitutional. “It doesn’t have to have a massive impact on Georgians if Congress steps up” and agrees together to rewrite the law and reinstate the protections for patients. “Our job is to make sure it’s done legally and properly. The ends can’t justify the means.”
The good and not-so-good
The ruling by U.S. District Court Judge Reed O’Connor applies nationwide, but Democratic-led states planned to immediately appeal it, first to the U.S. Circuit Court of Appeals in New Orleans and then to the U.S. Supreme Court.
No matter the outcome, the Ambetter insurance company, one of four on the ACA exchange in Georgia, told its agents that it intended to try to keep offering its current plans. Blue Cross, also known as Anthem, did not have a statement.
For the moment, the Trump administration appears willing to wait out the appeals, according to statements from White House spokeswoman Sarah Huckabee Sanders and administration health official Seema Verma.
That’s some comfort to Heidi Moore of Alpharetta, whose son Jacob just turned 18. He was diagnosed with cancer in 2009, just before the ACA took effect, and also has Down syndrome and related health issues. Her life revolves around health care.
“The thing is that with the assurances in the ACA right now, Jacob can continue to be under our private insurance,” Moore said. “We have 15 specialty doctors for my son. The majority of specialty doctors in the adult world do not accept Medicaid. And that’s a fact.”
The ruling endangers that, and “it puts the fear in me,” she said. “We’ve worked so hard for Jacob to do as well as he is right now. The last thing I want us to do is to not get the health care he needs to maintain that quality of life. It’s scary for a parent.”
McBrayer, the insurance salesman, has seen his own customers like Moore, and he understands that the ACA has done a lot of good. But he said one can’t overlook the people it doesn’t help.
He feels for the people who can’t afford premiums these days because they make just above the cutoff to qualify for a federal subsidy, say $49,000 and above for a single person.
“There’s people that’s getting hurt right now,” McBrayer said. “I just don’t see how the law as it is is sustainable.” He understands that the way those people would get more affordable plans is for customers to be allowed to roll the dice again: Buy insurance that doesn’t cover things they might need.
“I’m not sure exactly what I do want,” McBrayer said; he more adamantly opposed the law before he saw some people benefit from it over time. “I see, because of this law, the faults that we had before,” he added. “But we still have the (new) faults.”
Incentive to act?
O’Connor’s ruling accepted the reasoning of the lawsuit. It argued that since Congress zeroed out the tax penalty for not having insurance, the “individual mandate” for insurance wasn’t really a tax anymore. And since the law had been passed under Congress’ taxing authority, every piece of it had to go.
Attorney General Carr dismissed fears of what striking down the law could do in Georgia. Although Congress has so far been unable to agree on a replacement for the ACA, crisis spurs them to act, he said. Before becoming attorney general, Carr served as an aide to U.S. Sen. Johnny Isakson, R-Ga.
“I have yet to meet a Georgian or an American that doesn’t believe that pre-existing conditions should be covered,” Carr said. “So should choice. I should be able to keep my doctor if I want to. We need to drive down cost of health care, we need to increase competition. Those are the things that Congress can do when they go back to the table and pass the bill and do it the right way. And I’m sure that they will do that.”
U.S. Rep. Buddy Carter, R-Pooler, agreed.
“Quite honestly, I think (the ruling is) probably what it takes to get us to come up with an alternative to what has obviously been a failed experiment,” Carter said. “We need to start over and begin from scratch.”
The backdrop could hardly be more divided, or more dramatic.
For the past two years, GOP congressional leaders and President Donald Trump have waged a campaign to dismantle the health care law, a signature campaign promise.
The state’s members of Congress voted strictly along party lines as congressional GOP leaders tried on multiple occasions to replace the 2010 law last year.
The Georgia delegation voted along partisan lines on the tax bill when it came up for consideration a year ago this month. Not a single House Democrat voted for the legislation.
In the House, Democratic leaders are now about to take control. And they vowed to take immediate action.
“When House Democrats take the gavel, the House of Representatives will move swiftly to formally intervene in the appeals process to uphold the life-saving protections for people with pre-existing conditions and reject Republicans’ effort to destroy the Affordable Care Act,” said Nancy Pelosi, D-Calif., who is expected to became speaker of the House when Democrats become the majority party in January. She was speaker when the ACA was passed in 2010.
Pelosi's party won back the House in part by vowing to protect pre-existing conditions, an argument embraced by winning Democratic candidates such as Lucy McBath in suburban congressional districts across the country. McBath edged out incumbent Karen Handel, R-Roswell.
U.S. Rep. Hank Johnson, D-Lithonia, stressed the popularity of the law’s protections as a reason Democrats won back control of the House.
“This 2018 campaign, which yielded Democrats 40 more seats, was premised upon in large part protecting and improving the protections of the Affordable Care Act, and I expect that’s what the House of Representatives under Democratic leadership is pass legislation to do just that,” he said. He called the decision “a fit of judicial activism.”
Whatever the ruling’s fate, nothing was holding back the feelings it unleashed.
“It baffles me, our moral compass,” said Moore.
Meanwhile, President Donald Trump spoke for many others across the country and the state: “Wow, but not surprisingly, ObamaCare was just ruled UNCONSTITUTIONAL by a highly respected judge in Texas. Great news for America!”