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: 300913

Reported Deaths: 5332
CountyCasesDeaths
Marion41330845
Lake26364448
Allen17299290
Elkhart16665212
St. Joseph16319220
Hamilton12459164
Vanderburgh9428112
Tippecanoe826727
Porter791279
Johnson6139164
Hendricks5807154
Vigo574474
Monroe525247
Clark495374
Delaware4789103
Madison4760119
LaPorte446894
Kosciusko446139
Howard325575
Warrick316072
Floyd306177
Bartholomew303262
Wayne295261
Cass293431
Marshall289944
Grant258747
Noble246846
Hancock243749
Henry237136
Boone235154
Dubois230430
Dearborn208829
Jackson206033
Morgan200643
Knox178017
Gibson177022
Clinton174920
Shelby174554
Lawrence171646
DeKalb171229
Adams165219
Miami155114
Wabash153018
Daviess152243
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Posey118913
Putnam118326
Wells118327
Randolph117819
White117421
Clay115621
Jefferson114214
Greene100253
Scott99818
Jay95012
Starke89221
Sullivan86615
Fulton81117
Perry80921
Jennings80514
Spencer8047
Fountain7378
Washington7176
Carroll66813
Franklin65925
Orange65728
Vermillion5832
Owen5816
Parke5416
Newton54012
Tipton53726
Rush5216
Blackford51211
Pike50218
Pulaski36810
Martin3485
Brown3263
Benton3251
Crawford2781
Union2621
Switzerland2473
Warren2352
Ohio2257
Unassigned0265

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 363304

Reported Deaths: 6020
CountyCasesDeaths
Franklin49267665
Cuyahoga35214736
Hamilton29462371
Montgomery19636225
Butler14472144
Lucas14033409
Summit12962310
Stark8529197
Warren798975
Mahoning7068299
Lake662766
Lorain623697
Clermont563946
Delaware540335
Licking535875
Fairfield523763
Trumbull5159144
Greene510563
Clark501064
Allen460685
Marion457751
Wood4394107
Medina428654
Miami416465
Pickaway396448
Columbiana339597
Portage334471
Tuscarawas317557
Wayne314993
Richland306732
Mercer284737
Ross239259
Hancock232736
Muskingum231910
Auglaize223230
Putnam221449
Erie217165
Darke217058
Ashtabula215753
Geauga197351
Scioto193615
Union18658
Lawrence185436
Shelby184815
Athens18454
Seneca173118
Belmont158529
Madison156218
Sandusky152327
Preble148421
Huron147518
Defiance137921
Holmes137739
Logan123613
Knox122518
Fulton122025
Crawford119116
Ottawa118930
Washington116427
Clinton103414
Ashland102722
Williams10238
Jefferson10124
Highland99517
Henry98422
Brown9644
Champaign9345
Jackson90312
Van Wert8976
Fayette89217
Hardin86118
Morrow8552
Guernsey83313
Coshocton81413
Perry77012
Adams75012
Pike7261
Wyandot70516
Gallia70413
Paulding62710
Hocking61011
Noble59722
Carroll44310
Meigs37612
Monroe31021
Morgan2395
Vinton2105
Harrison1913
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