On December 18, 2019, the 5th Circuit Court of Appeals struck down the Patient Protection and Affordable Care Act (ACA) individual mandate that all Americans have health insurance. The rest of the law will stay in place for now as it is sent back to the lower court that must now determine whether the other parts of the ACA can stand without the individual mandate.
While the ACA will remain the law of the land for now, it’s important for all people, including cancer patients, survivors, and their loved ones, to understand what this ruling means for them.
The Affordable Care Act
In 2010, the ACA, also referred to as ObamaCare, was passed into law. Although we’ve seen multiple attempts to repeal the law, the ACA has remained in place for nearly ten years and 20 million people have gained insurance as a result (Center on Budget and Policy Priorities, 2019). There is also evidence that points toward a trend in early-state diagnosis for colorectal, lung, breast, and pancreatic cancer in states that increased access to health care through Medicaid expansion because of the ACA (Jemal et al., 2017).
Tax Cuts and Jobs Act
In December 2017, the U.S. Congress passed the Tax Cuts and Jobs Act into law. Among other provisions, the law repealed the ACA’s “individual shared responsibility penalty,” otherwise known as the individual mandate, which imposed a penalty through a tax payment for individuals who did not secure health care coverage. The penalty is effectively no longer applicable because the bill reduced the amount individuals would owe to nothing. This provision of the ACA had been created to ensure that people who were both healthy and those living with chronic illnesses would purchase health care coverage to ensure a “balance the marketplace”.
Texas vs. the United States
In 2018 the Texas Attorney General, along with 18 other state attorney generals, two governors, and two individuals filed a lawsuit in the state of Texas, alleging that the ACA has become unconstitutional since the repeal of the individual shared responsibility penalty. District Court Judge Reed O’Connor ruled in favor of the plaintiffs who argued that because the coverage mandate was repealed as part of the Tax Cuts and Jobs Act, the entire law is invalid and must be struck down. This ruling was appealed, and the 5th Circuit Court took up the case. In a 2-1 decision, the 5th Circuit ruled that the mandate is unconstitutional, but not the whole ACA, leaving the rest of the law in limbo.
What happens next?
We expect this case to continue to be tied up within the courts. The Washington Post reports that this ruling “almost certainly will bring the health-care law before the Supreme Court for a third time.” With the appeals court ruling, the case is being sent back to District Court Judge O’Connor, who already has held the law unconstitutional, for analysis regarding whether the ACA can stand without the individual mandate.
Additionally, California Attorney General Xavier Becerra has appealed the 5th Circuit Court decision to the Supreme Court. If the Supreme Court agrees to hear the case, it would end the uncertainty created by the lawsuit and the court's decision, Becerra said. However, they could decline to take up the case or push the case past the 2020 term.
The appeals court decision, he said, "has created real and long-term uncertainty for all Americans, but certainly those who have used the essential benefits of the Affordable Care Act to cover themselves and their family."
Health care is already at the forefront of the 2020 presidential election, and this decision ensures that health care and the ACA will continue to be front and center in both the primaries and general election.
What could this mean to you and other people with chronic or life-threatening illnesses like cancer?
The ACA will remain the law of the land for now. Those who are enrolled in ACA plans for 2020, are enrolled in Medicaid as a result of their state expanding Medicaid, or those protected by pre-existing condition provisions of the ACA will continue to enjoy these benefits as the case continues.
If the ACA is ultimately ruled unconstitutional and is therefore dismantled, it could have devastating effects on access to care, removing many essential patient protections that cancer patients and survivors depend on. Insurers could return to the practice of denying coverage to certain people, canceling coverage midyear, charging higher premiums to older people or those with pre-existing conditions, setting lifetime or annual limits, and refusing coverage for essential health benefits like prescription drugs, mental health care, emergency care, and more.
Now is the time to contact your members of Congress and ask them to uphold their promise and protect ACA provisions that ensure cancer patients and survivors continue to have access to quality, comprehensive, and affordable care.
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Editors Note: In March 2020 the Supreme Court agreed to hear the case in their next term, which begins in October 2020.
Center on Budget and Policy Priorities. (2019). Chart Book: Accomplishments of Affordable Care Act. Retrieved from https://www.cbpp.org/research/health/chart-book-accomplishments-of-affordable-care-act
Goldstein, A. (2019, December 19). Individual mandate ruled unconstitutional, ACA in limbo. The Washington Post. Retrieved from https://www.washingtonpost.com/health/appeals-court-rules-acas-individual-mandate-unconstitutional-lower-court-to-decide-whether-rest-of-law-can-stand-without-it/2019/12/18/3443fd3e-c03c-11e9-b873-63ace636af08_story.html
Jemal, A., Lin, C.C., Davidoff, A.J., Han, X. (2017). Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients With Cancer After the Affordable Care Act. Journal of Clinical Oncology, 35:35, 3906-3915. https://ascopubs.org/doi/full/10.1200/JCO.2017.73.7817