The Response
The Justice Department filed a brief saying that it would not defend the ACA. In its brief and accompanying letter to the House and Senate leaders, the Justice Department stated its agreement with the Republican-led states that brought the lawsuit. Attorney General Jeff Sessions noted that the Justice Department’s position was taken with the approval of President Donald Trump.
A group of 16 Democratic-led states and the District of Columbia intervened in the lawsuit to defend the ACA. The intervening states include California, Connecticut, Delaware, Hawaii, Illinois, Kentucky, Massachusetts, Minnesota, North Carolina, New Jersey, New York, Oregon, Rhode Island, Virginia, Vermont, Washington, and the District of Columbia. The case is styled Texas v. Azar.
The Hearing
U.S. District Judge Reed O’Connor heard oral arguments on the case in the United States District Court in the Northern District of Texas. Los Angeles Times reporter Noam Levey attended the arguments and reported that O’Connor appeared very interested in whether some parts of the ACA should be invalidated if the insurance requirement is ruled unconstitutional because it is no longer considered a tax.
Levey wrote, “During the hearing, O’Connor returned repeatedly to arguments that architects of the healthcare law made in 2010 and afterward that requiring people to have insurance was crucial to the popular consumer protections in the law, including bans on insurance companies turning away sick customers or charging them higher premiums, practices that were commonplace before the law was enacted.”
O’Connor noted that the Supreme Court had relied on those arguments when the ACA had come before the court previously.
California Deputy Attorney General Nimrod Elias argued on behalf of California and the other states defending the ACA. Elias said, “Congress wished to leave this law in place…That should be the guidepost.” Elias quoted several Republican lawmakers who said during the debate over the law that they did not want to eliminate the patient protections.
Physician Group Interest
A coalition of physician groups filed an amici curiae brief in to support the ACA. The participating groups included the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry.
The physician groups argued that the states lacked standing to bring the suit, that the minimum essential coverage provision remains a valid exercise of Congress’s taxation power, that the minimum coverage provision is severable from the remainder of the ACA, and that the requested remedies will wreak havoc on American health care.
The coalition argued, “Invalidating the guaranteed-issue and community rating provisions—or the entire ACA—would have a devastating impact on doctors, patients, and the American health care system as a whole. Put simply, the consequences of any form of inseverability would eliminate the ‘[h]istoric gains in health insurance coverage have been achieved since the implementation of the Affordable Care Act.’”
The coalition noted, “The ACA’s ‘nationwide protections for Americans with pre-existing health conditions’ has played a ‘key role’ in allowing 3.6 million people to obtain affordable health insurance. Severing those vital insurance reforms would leave millions without much-needed insurance. On top of that, the [Congressional Budget Office] estimated that repealing ‘major provisions’ of the ACA would cause 32 million people to become uninsured and average premiums in the nongroup market to double by 2026.”
The coalition also pointed to the nonpartisan Rand Corporation’s conclusion that the repeal of the ACA would increase the federal deficit by $33.1 billion annually.
