Obamacare's 'essential benefits' explained

Under Obamacare, all insurance providers have to ensure a minimum level of coverage. CNN Chief Medical Correspondent Dr. Sanjay Gupta reports.

Posted: Dec 16, 2018 9:49 PM
Updated: Dec 16, 2018 9:59 PM

Late on Friday, a federal district judge in Texas, Reed O'Connor, dropped a bomb on the Affordable Care Act, and indeed on the entire American health care system.

His ruling, in Texas v. U.S., was a victory for the 20 Republican state attorneys general and governors who had brought the case in February, asking the court to block operation of the health care law. They based their attack on the law's requirement that people either buy health insurance or pay a penalty, which opponents of the law have long called an unconstitutional mandate.

In a landmark decision in 2012, the Supreme Court upheld the law by declaring that mandate was actually a tax, which Congress had the authority to impose. But when Congress reduced the tax to zero last year, the plaintiffs argued that now -- without its individual-responsibility enforcement mechanism -- the entire Affordable Care Act was suddenly unconstitutional.

Judge O'Connor agreed. He said further that the law and its mandate could not be separated, and with this key part missing, the whole law should collapse, like a pillar of blocks in the game Jenga.

The scope of Judge O'Connor's judgment is breathtaking. The ACA contains ten titles and hundreds of individual provisions governing every corner of our health care system. The invalidation of the ACA, if upheld on appeal, would affect virtually every American.

Of course, millions of individuals who purchase their insurance directly from insurers or through the marketplaces would lose the ACA's preexisting condition protections. Older Americans and women could again be discriminated against as well.

Millions of individuals and families covered through the ACA's Medicaid expansions would lose coverage — even in states that have recently passed referenda to expand coverage — but other Medicaid beneficiaries would lose benefits conferred by the ACA as well.

Medicare beneficiaries would lose preventive-services coverage and could see the "donut hole" reopen, imposing higher drug costs. Indeed, the order may invalidate current ACA regulations governing Medicare payments, throwing the Medicare program into chaos.

Most Americans, who have coverage through their employer, would lose their right to preventive services and coverage of children to age 26 and see lifetime and annual dollar limits of coverage reappear. ACA reforms to the Indian Health Service or provisions for FDA approval of generic biologic drugs would disappear. Fraud and abuse protections included in the ACA would no longer be effective.

In deciding to wreak this destruction on the American health care system, Judge O'Connor arrogated to himself authority that rightly belongs with Congress. A Republican Congress spent most of 2017 debating to what extent it wanted to repeal the ACA. In the end, it only changed one small provision: reducing the shared responsibility tax to $0.

Judge O'Connor believes that in doing so, Congress pulled a grenade pin, exploding the entire law. But numerous Republicans, both during the debate on the vote on the tax law and since, have made it clear that was not what they did.

Judge O'Connor points to the "findings" from the original ACA itself to claim that the mandate was "essential" to various provisions of the law, but those findings were included to bolster arguments that the mandate was constitutional as a legal requirement and were not intended to make the rest of the law dependent on the mandate.

Republicans in Congress repeatedly tried and failed to repeal the ACA. It is not up to an unelected judge to do it himself.

So, what does Judge O'Connor's judgment mean? He specifically did not enter an order blocking the operation of the law, so it remains in effect. O'Connor only found two individuals had standing to challenge the law, so arguably the ruling only applies to them.

Another judge is considering a case brought by Maryland to uphold the ACA, so we may get dueling judgments. An earlier appellate court decision, involving a number of the states in this case, invalidated the individual mandate but held the entire remainder of the ACA to be valid. Any noncompliance with the law may be challenged in other courts.

California will appeal Judge O'Connor's decision and the Trump administration may appeal parts of it as well. It will likely be reversed on appeal and may never get to the Supreme Court. It is simply the opinion of one district court judge.

But it will surely cause chaos and confusion throughout the health care system, as the federal government's lawyer predicted at oral arguments. No doubt that is what Judge O'Connor wanted.

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 926604

Reported Deaths: 15083
CountyCasesDeaths
Marion1262201958
Lake626901087
Allen52772747
Hamilton43283445
St. Joseph41475584
Elkhart33129488
Vanderburgh29927439
Tippecanoe26589247
Johnson23267415
Hendricks21902340
Porter21473341
Clark17150224
Madison17065379
Vigo15815273
Monroe14298190
LaPorte14108237
Delaware13771219
Howard13635262
Kosciusko11232134
Hancock10637160
Warrick10523176
Bartholomew10341167
Floyd10200202
Wayne9690218
Grant8939196
Morgan8734158
Boone8299109
Dubois7596123
Henry7469128
Dearborn745187
Noble7294101
Marshall7237128
Cass7097117
Lawrence6862150
Shelby6457107
Jackson643981
Gibson6036106
Harrison595585
Huntington591891
Montgomery5706102
DeKalb563591
Knox537599
Miami531983
Clinton527164
Putnam525367
Whitley516251
Steuben486367
Wabash477492
Jasper471961
Jefferson461991
Ripley444175
Adams439365
Daviess4064106
Scott394963
White386257
Clay382356
Greene380189
Wells379683
Decatur379595
Fayette367176
Posey354941
Jennings346356
Washington325847
LaGrange315774
Spencer313034
Fountain309753
Randolph305487
Sullivan299447
Owen279161
Starke272761
Orange272659
Fulton268851
Jay250634
Perry247451
Carroll241127
Franklin233637
Vermillion229750
Rush228930
Parke215220
Tipton206754
Pike202538
Blackford165634
Pulaski158751
Crawford142818
Newton140742
Benton139816
Brown132646
Martin126916
Switzerland123510
Warren113416
Union93511
Ohio77211
Unassigned0468

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 1342777

Reported Deaths: 21471
CountyCasesDeaths
Franklin1502191556
Cuyahoga1327732318
Hamilton962791318
Montgomery659161136
Summit555141045
Lucas50248862
Butler46732653
Stark40741974
Lorain31004529
Warren29609328
Mahoning26462637
Clermont25206287
Lake24339416
Delaware22014143
Licking20180241
Fairfield20139221
Greene19955268
Trumbull19500508
Medina19478286
Clark17565325
Richland15949231
Portage15851228
Wood15438208
Allen13875256
Miami13549249
Muskingum12261149
Wayne11647237
Columbiana11344239
Tuscarawas10657265
Marion10509148
Pickaway10301128
Scioto10082126
Erie9618171
Ross9209174
Lawrence8516116
Hancock8298141
Ashtabula8180185
Geauga8066155
Belmont7966184
Jefferson7324168
Huron7253127
Union717849
Washington7037119
Athens681064
Sandusky6734133
Darke6559136
Knox6475121
Seneca6237137
Ashland5808112
Auglaize580488
Shelby5654101
Mercer552190
Brown551068
Defiance5361100
Madison535170
Crawford5299114
Highland527581
Fulton520082
Clinton515980
Logan503182
Preble4902110
Putnam4778106
Guernsey454661
Williams448281
Champaign436264
Perry432152
Ottawa431184
Jackson413260
Pike378941
Morrow369150
Fayette367652
Coshocton359466
Hardin350069
Adams348069
Gallia338054
Holmes3197108
Henry318868
Van Wert307170
Hocking291669
Wyandot276158
Carroll256752
Paulding236442
Meigs205242
Monroe185049
Noble164840
Morgan159228
Harrison151940
Vinton133918
Unassigned05
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