Why current court battle represents existential threat to Obamacare


JUDY WOODRUFF: The Affordable Care Act, often
referred to as Obamacare, has faced a series of threats to its existence ever since it
became law nearly a decade ago. The latest challenge, a lawsuit filed by Republican
governors and attorneys general, and backed by President Trump. The law was the subject of a crucial court
hearing today. John Yang is here to fill us in — John. JOHN YANG: Judy, a three-judge panel of a
federal appeals court in New Orleans heard about 90 minutes of oral arguments today in
this case, with enormous stakes for millions of Americans. Congress set the stage for this challenge
in the tax bill that President Trump signed into law in 2017. The measure eliminated the penalty on Americans
who failed to maintain health insurance. The Republican governors and attorneys general
argue that, since the Supreme Court upheld the health care law as a valid exercise of
Congress’ taxing authority, taking the tax away makes all of the law unconstitutional. Late last year, a federal district judge in
Texas agreed. At first, the Trump administration said some
of the law should remain. But in March, the Justice Department reversed
course. Since the administration is not defending
the law, Democratic attorneys general and members of the House are leading the appeal. Since its passage, the health care law has
ingrained itself deeply into the U.S. health care system. More than 20 million more Americans are now
covered by its provisions. It has hundreds of other provisions that have
directly and indirectly changed health care, including protections for people with preexisting
medical conditions, and allowing children to be covered by their parents’ health plans
up to age 26. The suit could send the matter back to the
Supreme Court for the third time in the middle of the 2020 campaign. Today, Senator Patty Murray of Washington
state signaled that Democrats would make it an issue. SEN. PATTY MURRAY (D-WA): People are watching this
very closely. They are not going to forget who stood up
to defend their health care, and who brought a partisan lawsuit to throw it out the window. JOHN YANG: If the law is struck down, Senate
Majority Leader Mitch McConnell said lawmakers would act quickly to preserve one of its most
popular provisions. SEN. MITCH MCCONNELL (R-KY): I think the important
thing for the public to know is, there’s nobody in the Senate is not in favor of covering
preexisting conditions. Nobody. And if that were, under any of these scenarios
to go away, we would act quickly on a bipartisan basis to restore it. JOHN YANG: The judges gave no indication of
when they will rule in the case. Sam Baker, the health care editor at Axios,
was in the courtroom this afternoon and joins us now. Sam, you also cover the Supreme Court. You’re used to hearing these arguments like
today. I want to play a little bit of that. The issue of whether the entire bill falls
or the entire law falls because one provision falls is something called severability. And Judge Kurt Engelhardt, who was nominated
by President Trump, pressed the Democratic lawyer on congressional intent on that point. Let’s take a listen. JUDGE KURT ENGELHARDT, U.S. Court of Appeals
for the Fifth Circuit: Couldn’t Congress have said, and, oh, by the way, we think all of
these provisions are such excellent ideas and helpful to the public that, if any of
them go by the wayside, well, then we would want all of these to — the remainder to continue
to apply? MAN: But the Supreme Court had said that Congress’
silence on this point is just that, silence, and it doesn’t create a presumption against
severability. JOHN YANG: Sam, what — help us understand
that. What do you make of that exchange? SAM BAKER, Axios: It really gets right to
the core of what’s going on here. So these arguments today sort of almost assumed
that the individual mandate is probably now unconstitutional. The court hasn’t actually decided that. And its decision wouldn’t be final. But, you know, the big question that they
sort of have to debate is, all right, well, if we say the individual mandate goes away,
how much else goes away? (CROSSTALK) JOHN YANG: Sorry. Go ahead. SAM BAKER: Well, there was a time when the
Trump administration was saying, well, just take out the mandate and then also protections
for people with preexisting conditions. Now, they have changed that and say, you have
to strike down the whole law. And that’s, as you said, raising all these
questions about other largely unrelated provisions. JOHN YANG: And the individual mandate, if
it goes away, there’s really no enforcement mechanism now that that penalty’s been taken
away. So would there be much of an effect if only
the individual mandate falls? SAM BAKER: No, there wouldn’t. And I if think, if that’s what happens, Democrats
will probably breathe a sigh of relief and call that a win and live to fight another
day. JOHN YANG: Talk about the questioning from
the judges about the other provisions of the law, about the other parts, and whether they
would fall away as well. SAM BAKER: Yes. This really — you know, the — we’re all
sort of used to — when the Affordable Care Act was first passed and when it went to the
Supreme Court the first time, we heard so much about how the individual mandate is wrapped
up with the protections for people with preexisting conditions, and it’s all sort of intertwined,
and you can’t kick one leg out from under that stool. The mandate didn’t turn out in practice to
be quite as potent as people thought it would be. Then Congress has gone ahead and repealed
one part of that. But there’s still a lot of thinking sort of
along the lines of, look, you told us that this one thing couldn’t go away in isolation. So, if we’re going to strike that down, it
seems like we probably have to strike down at least some more here. The first things to go would probably be the
biggest and most popular. That’s protections for preexisting conditions. But there was a lot of — there were a lot
of questions today about menu labeling. That’s a part of the Affordable Care Act that
many people maybe don’t know about. That’s why fast food restaurants have to have
calorie labels on their menus. That’s because of Obamacare. And a couple of the judges were sort of saying,
well, I don’t know, do we really have to throw that away because of the individual mandate? Maybe yes, maybe no. But those are the kinds of questions they’re
going to have to answer or figure out a new process to get an answer to. JOHN YANG: And it really does point out how
pervasive or how the Affordable Care Act has affected, directly and indirectly, so much
of the health care system. SAM BAKER: Yes, that’s exactly right. I mean, here, you would be getting rid of
the private insurance coverage that the law enables people to buy, the Medicaid expansion,
these really huge structural changes that we’re sort of all used to because they cover
tens of millions of people. The Affordable Care Act also created a pathway
for the FDA to start approving a new class of drugs. And they have been using it. There are drugs on the market that were approved
that way. So if that approval pathway goes away, the
drug companies are already sort of starting to use it to create that class of drugs. They’d have to stop. Menu labeling is one thing. There’s a lot of changes that the law made
to Medicare, the new authorities that it gave to any administration on Medicare, that even
the Trump administration is making pretty substantial use out of, trying to make that
program more efficient. It changed some criminal statutes in terms
of Medicare fraud. There were questions today about, can you
still prosecute people for Medicare fraud, because that was technically — this or that
statute was amended by the Affordable Care Act. It’s really — especially after all this time,
as you said, it’s just sort of seeped in everywhere. JOHN YANG: Well, we will have to wait and
see what the decision will be later this year — or perhaps later this year. Sam Baker, the health care editor at Axios,
thank you very much. SAM BAKER: My pleasure.

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