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The history of Obamacare

CNN's Cyril Vanier gives a history of the Affordable Care Act following the news that a Texas federal judge struck down the law, citing the individual mandate coverage as unconstitutional.

Posted: Dec 16, 2018 9:15 PM
Updated: Dec 16, 2018 9:15 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: 1005797

Reported Deaths: 16449
CountyCasesDeaths
Marion1353572119
Lake663011164
Allen57820801
Hamilton46296464
St. Joseph44311613
Elkhart35888509
Vanderburgh32214480
Tippecanoe27898258
Johnson25056445
Hendricks23854359
Porter22890365
Madison18724409
Clark18540252
Vigo17449303
Monroe15242199
LaPorte15124250
Delaware15043261
Howard14719289
Kosciusko12285147
Hancock11709175
Bartholomew11602180
Warrick11287189
Floyd11082215
Wayne10965253
Grant10051220
Morgan9457176
Boone8913116
Dubois8263131
Dearborn820893
Henry8200152
Noble8017106
Marshall7916135
Cass7528121
Lawrence7447171
Shelby7176119
Jackson697289
Gibson6584115
Harrison647591
Knox6418106
Huntington6385100
DeKalb630699
Montgomery6252110
Miami592298
Putnam580078
Clinton574971
Whitley564255
Steuben560676
Wabash5324104
Jasper529879
Jefferson510297
Ripley499886
Adams481576
Daviess4670114
Scott438574
Greene424496
Wells423088
Clay422060
White418164
Decatur4164102
Fayette406187
Jennings386661
Posey376644
LaGrange357678
Washington357651
Randolph344499
Spencer339543
Fountain334760
Sullivan328652
Starke316470
Owen314170
Fulton309467
Orange293564
Jay284145
Franklin265443
Perry265352
Rush261332
Carroll261133
Vermillion257754
Parke231126
Pike228843
Tipton227559
Blackford192642
Pulaski183457
Crawford159223
Newton157848
Benton150217
Brown146147
Martin138219
Switzerland134911
Warren121016
Union107016
Ohio84513
Unassigned0540

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 1511760

Reported Deaths: 23616
CountyCasesDeaths
Franklin1636861666
Cuyahoga1457252442
Hamilton1050421416
Montgomery737101254
Summit614971105
Lucas56058912
Butler51383711
Stark464421056
Lorain35443584
Warren32687373
Mahoning30598675
Clermont28106326
Lake26907443
Delaware24114162
Licking23820287
Trumbull22742556
Fairfield22309246
Greene22212320
Medina21941311
Clark19757351
Richland18500285
Portage17857250
Wood17394221
Allen15905269
Miami15487299
Muskingum14737185
Columbiana13940269
Wayne13722265
Tuscarawas12643304
Marion11906175
Scioto11432161
Pickaway11346141
Erie10811181
Ross10532198
Lawrence9725153
Ashtabula9658200
Hancock9649150
Belmont9262206
Geauga8906157
Jefferson8531197
Huron8338141
Union816557
Washington8066138
Sandusky7790148
Athens773676
Knox7679141
Darke7618155
Seneca7306144
Ashland6917126
Auglaize678097
Shelby6493113
Brown633387
Crawford6245130
Defiance6162103
Mercer612893
Fulton599296
Highland596899
Madison592176
Guernsey583468
Logan582795
Clinton581191
Preble5692122
Putnam5301108
Williams526185
Perry516563
Champaign510372
Jackson506571
Ottawa484086
Coshocton478783
Morrow456656
Pike432763
Fayette427461
Hardin416678
Gallia416266
Adams415392
Van Wert369579
Henry362571
Holmes3619123
Hocking355579
Wyandot322261
Carroll300659
Paulding279147
Meigs263350
Monroe214854
Noble198946
Morgan193232
Harrison180143
Vinton165125
Unassigned05
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