In a late-night decision last Friday, a federal judge in Texas found that the Affordable Care Act was invalid in its entirety. The judge reasoned that the Act’s “individual mandate” requiring almost all Americans to obtain health insurance was unconstitutional because it could no longer be sustained under Congress’s taxing power—the mandate was no longer backed by a penalty that raised money for the Treasury. And the judge believed that Congress would not have enacted any of the remainder of the ACA without the mandate.

Here are five key takeaways from the decision:

1. The court’s decision does not change anything. The court did not issue an injunction that would stop the Administration or anyone else from implementing the Act. Although the ruling creates new, needless uncertainty, the law today is exactly the same as it was before the decision.

2. The decision was not a surprise. The judge assigned to the case has in the past issued decisions favored by groups opposed to the Affordable Care Act. So while the ruling is unwelcome, it was not unexpected.

3. The ruling has been criticized across the political spectrum. Even legal scholars and commentators that have been critical of the Affordable Care Act in the past—such as the Wall Street Journal editorial board—have panned the decision and predicted that it will be overturned on appeal.  

4. This federal judge will not have the last say. The Democratic attorneys general that intervened in support of the Act have already asked for permission to immediately appeal the decision to the U.S. Court of Appeals for the Fifth Circuit. 

5. The AHA will continue to fight to preserve the Affordable Care Act and its protections for patients and access to care. The AHA, together with other national hospital associations, filed a brief in support of the law in the trial court. The brief explained the flaws in the plaintiffs’ legal argument and emphasized the impact on patients and hospitals if the Act were struck down. The AHA will continue those efforts in the Fifth Circuit and—if necessary—the Supreme Court.

Marotta is a Senior Associate at Hogan Lovells and AHA outside counsel. He was principal author of the AHA’s amicus brief referenced above.


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