This past week, a Texas judge unexpectedly ruled the Affordable Care Act (affectionately known as Obamacare) as unconstitutional. The gravity of the ruling is quite heavy, as it could cause all sorts of changes within the health insurance industry. So, what are the effects of the ruling and how soon will they create changes in the marketplace?
It’s not entirely clear how things will change in the short term, as many might wait until the case makes its way to the Supreme Court. However, some states, which have already disagreed with the constitutionality of Obamacare and had previously filed suit with the Supreme Court (but lost), might immediately begin ignoring many of the provision of the Act. This could mean that they might choose not to enforce some of the larger provisions of the ACA, such as the requirement to accept all pre-existing conditions and the mandate that all employers with more than 50 employees must offer an ACA-approved plan.
However, all of the insurance carriers have already put their plans in place for the 2019 year, and those plans will not change during their terms that were set during open enrollment. The companies will file their new plans for approval by the states in the spring, and so we will have to see if the Supreme Court has an alternative ruling by then and whether insurance companies will begin making changes to their plans and pricing structures, as well as underwriting guidelines. And, since it is the ACA that requires the open enrollment period, the new plans might be available for enrollment right after approval. Until the Supreme Court offers a ruling on the case, things are going to be in a little bit of a state of turmoil as states and insurance companies make decisions about whether or not to uphold the ACA provisions.
At the minimum, both Republicans and Democrats agree on a requirement to cover pre-existing conditions. If the ACA fails conditionality with SCOTUS, then it is likely that a bill can be quickly passed that has at least that requirement. There might also be some agreement among both parties for more control over opioid medications. Democrats are likely to present a more extensive means of control over the healthcare industry and the House of Representatives will likely put up some sort of bill for Medicare for All for a vote, which is highly unlikely to pass with Republicans in the Senate. Republicans would favor creating requirements for some coverage in insurance by opening insurance to be sold across state lines in an effort to create more competition.
How these two parties will reconcile their differences on health coverage remains to be seen, but it will be considered important enough to make some sort of changes, should the ACA not stand up to SCOTUS scrutiny.
We know that it is very likely both parties will make sure the pre-existing conditions provisions of ACA will continue. It is possible that requirements such as coverage for maternity and certain other things may also stay in place. In the end, things will not fully return to the way they were pre-ACA, but it is likely a less extensive form of the reforms made by ACA will continue. At this point, things skew a little bit Republican, since Trump also controls the executive branch. That gives some aid to Senate Republicans, and there are many compromises that can be made with the House in areas of agreement.
With SCOTUS now having a secure majority on the conservative side of things, it is likely that ACA will fail. However, we never really never know exactly how justices will rule. Once in office, justices have no loyalties and answer to no political affiliations. They aren’t bound by their parties in the same way as elected politicians are. We just don’t fully know what to expect. So, it is unlikely that libertarian thinkers will get the sort of reforms they would like to see in the US healthcare system, but things will be slightly better than they were under Obamacare.