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KHN’s ‘What The Health?’: ACA Still Under A Cloud After Court Ruling

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The fate of the Affordable Care Act continues to be in doubt after a federal appeals court ruling in New Orleans. By a 2-1 vote, the three-judge panel ruled that the “individual mandate” provision of the health law — which requires people to have health coverage — is unconstitutional now that Congress has reduced the penalty to zero. But the judges sent the case back to the lower court to determine how much else of the law can remain in light of that finding.

Meanwhile, on Capitol Hill, lawmakers are preparing to leave for the year having finished a gigantic spending bill that includes many changes to health policy. However, the two biggest health priorities of the year — doing something about “surprise” medical bills and prescription drug prices — remain undone.

This week’s panelists are Julie Rovner from Kaiser Health News, Margot Sanger-Katz of The New York Times, Kimberly Leonard of the Washington Examiner and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • The federal appeals court decision on the future of the ACA means the District Court judge will likely need to take into consideration Congress’ intent when it dropped the penalty for not having insurance but made no other changes to the law.
  • Although the legal ramifications of the 5th Circuit Court of Appeals’ decision won’t be clear for months, the ruling could affect the 2020 campaign season. Republicans may be relieved that the future of the ACA is not front and center, but Democrats have an opening to argue that the law is still very much endangered, as well as its popular provision guaranteeing coverage to people with preexisting medical problems.
  • One of the surprises in Congress’ spending bill was a provision that preserves states’ ability to approve “silver loading” by insurers on the ACA’s insurance marketplaces. Under that workaround, insurers raise the prices of midlevel silver-level plans to recoup some expenses that the federal government is no longer paying. In some states, not only has this worked well for the insurer, it has pushed federal subsidies higher so that consumers can more easily buy plans.
  • The spending bill also included the CREATES Act, which aims to foster competition and drive down prescription drug costs by making it easier for generic drugmakers to develop and test their products.
  • The administration Wednesday unveiled a proposed rule for states to import drugs from Canada, but it is expected to take months, if not longer, before any federal approvals are issued.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The New York Times’ “In France, Dying at Home Can Mean a Long Wait for a Doctor,” by Norimitsu Onishi

Margot Sanger-Katz: ProPublica’s “What Happens When a Health Plan Has No Limits? An Acupuncturist Earns $677 a Session,” by Marshall Allen

Alice Miranda Ollstein: Nature’s “US Biomedical Agency Has Investigated Hundreds of Claims of Inappropriate Conduct This Year,” by Nidhi Subbaraman

Kimberly Leonard: BuzzFeed News’ “The Last Decade Was Disastrous for Abortion Rights. Advocates Are Trying to Figure Out What’s Next,” by Ema O’Connor

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Related Topics

Courts Insurance Multimedia Pharmaceuticals The Health Law