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Ruling Backs States Opposed To Obamacare; White House Expects Appeal


Another effort to repeal the Affordable Care Act gained steam last night. A federal judge in Texas ruled that the law is unconstitutional. We're joined now by NPR's health policy correspondent, Alison Kodjak. Alison, thanks so much for coming in.

ALISON KODJAK, BYLINE: Thanks for having me, Scott.

SIMON: This decision was received last night. What's it say?

KODJAK: Well, it's a pretty sweeping decision, actually. This judge ruled that the entire Affordable Care Act, which famously ran more than a thousand pages long, was unconstitutional. The case was brought by 18 Republican attorneys general, and it was led by Texas AG Ken Paxton.

And, you know, in 2015, the Supreme Court ruled the Affordable Care Act is constitutional by calling the penalty for not having insurance a tax. And Congress has the power to tax people. So these attorneys general come in, and they argued that since Congress eliminated that tax penalty, the law can no longer stand. And that's what the judge agreed to last night. And he took that argument, and he struck down the entire law.

Now, it's going to be appealed.

SIMON: Yeah.

KODJAK: The attorney general of California's already said so.

SIMON: Any immediate effect on anyone's health care?

KODJAK: Well, it's unclear. But at least the Department of Health and Human Services is saying that the Affordable Care Act will stand as this works its way through courts. And the funny thing is today is the final day for...


KODJAK: ...Open enrollment for next year for people to get insurance. And on the website, there's actually a banner that says, this decision doesn't change open enrollment for now.

SIMON: What about political repercussions?

KODJAK: And that's a more complicated thing.

SIMON: Yeah.

KODJAK: So we just had midterm elections, as you know, and people really said health care is an important issue to them. And, you know, that's not a surprise. But lots of Republicans were running ads during this midterm, saying that they were the ones who are going to protect people's health care and, specifically, protect people with pre-existing conditions, which is one of those more sensitive issues around the Affordable Care Act. People want to make sure that if they're sick, they can get insurance.

But in this lawsuit, these Republican attorneys general specifically argue that the pre-existing condition protections had to be struck down when that mandate went away. So now you have Republicans sort of trying to play both sides, which is going to be difficult.

And then there's one other point that, you know, I think a lawyer made to me last night. Congress, in 2017, voted multiple times on whether to repeal the Affordable Care Act, and they didn't do it. And now this judge has gone in and done it by himself. And one lawyer called this a breathtaking act of judicial activism.

SIMON: In the end, if the Affordable Care Act goes away, if it's abolished, what can we expect to happen?

KODJAK: It will be - the repercussions will, you know, be far and wide. As I said, the law has more than a thousand pages. It touches every part of the health care system. So it's not just these marketplaces that we talk about most of the time.

The most immediate impact is Medicaid expansion. More than 10 million people have gotten health care because states have expanded Medicaid to a larger population. The law guarantees that people up to age 26 can get insurance through their parents. That's popular - that would go away. Again, the pre-existing condition protections - insurance companies have to give people coverage for their existing health problems.

But then, it also controls what Medicare pays doctors. It authorizes the Indian Health Service. It determines whether companies have to make accommodations for breastfeeding mothers. It makes chain restaurants put calorie counts on their menus. I mean, it's everywhere.

SIMON: Yeah. Well, I mean, a lot of things have changed in American life.


SIMON: And that was the idea of the legislation. There are Americans who have changed their jobs. There are Americans who've changed what they do in life...

KODJAK: Yeah. If this just goes away...

SIMON: ...To be able to get health care.

KODJAK: ...It would wreak havoc across the country in many ways.

SIMON: NPR's Alison Kodjak, thanks so much for being with us.

KODJAK: Thank you, Scott. Transcript provided by NPR, Copyright NPR.

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.