November 25, 2019

Any day now, we are expecting a ruling on the Health Care Repeal Lawsuit (Texas v. United States) from the 5th U.S. Circuit Court of Appeals. The stakes in this case are extraordinarily high, as a negative ruling could result in the entirety of the ACA being struck down. Regardless of the ruling, an appeal to the U.S. Supreme Court is all but guaranteed.

How did we get here?

In February 2018, 20 Republican attorneys general and governors filed a lawsuit arguing that the end of the individual mandate, which was zeroed out in the Tax Cut and Jobs Act of 2017, invalidates the entire ACA. President Trump’s DOJ chose not to defend the ACA shortly thereafter.

In December 2018, Judge Reed O’Connor agreed with the plaintiffs in a district court ruling and struck down the entire ACA.

This ruling was appealed to the 5th U.S. Circuit Court of Appeals. Oral arguments took place on July 9 as Texas v. U.S.

Healthcare Repeal Lawsuit: Timeline

February 2018: Texas and 19 other states sue the federal government in the U.S. District Court for the Northern District of Texas, arguing that the end of the individual mandate renders the entire Affordable Care Act (ACA) unconstitutional.

April 2018: Led by California Attorney General (AG) Xavier Becerra, 17 Democratic AGs intervene to defend the ACA.

June 2018: The Trump administration’s Department of Justice (DOJ) declines to defend the ACA provisions guaranteeing coverage for pre-existing conditions.

December 14, 2018: Federal District Judge Reed O’Connor issues a ruling declaring the entirety of the ACA unconstitutional. The ruling is widely criticized by both liberal and conservative legal experts and observers.

December 17, 2018: Judge O’Connor issues a stay on his ruling declaring the ACA invalid.

February 2019: Four more states (Colorado, Iowa, Michigan and Nevada) join California Attorney General Xavier Becerra’s coalition defending the ACA in federal court. The U.S. House of Representatives is also permitted to intervene in defense of the ACA.

March 25, 2019: The DOJ files a brief saying that the courts should strike down the entire ACA, not just protections for pre-existing conditions.

April 24, 2019: Texas and the plaintiff states file their brief arguing that the entirety of the ACA should be invalidated.

May 15, 2019: AG Becerra and the defense file reply briefs intervening on behalf of the ACA. July 9, 2019: Oral arguments begin in the 5th U.S. Circuit Court of Appeals in New Orleans.

Fall 2019: Decision expected from the 5th U.S. Circuit Court of Appeals. 

What's at stake?

  • This case has been part of a broad scale, coordinated attack on the ACA through legislation, litigation, executive action and regulatory changes. A broad ruling to invalidate the ACA could have several consequences including:
    • Stripping away care from tens of millions of people who receive health coverage through the ACA marketplaces;
    • Striking down Medicaid expansion, which has led more than 20 million people in over 35 states to access health care, many for the first time;
    • Rolling back consumer protections by ending guaranteed coverage for those with pre-existing conditions and eliminating  the 10 Essential Health Benefits (EHBs) enshrined in the law, including substance use disorders treatment, mental health treatment, maternal care and more;
    • Putting health insurers back in charge, likely forcing older adults and women to pay more for the same coverage;
    • Ending young people’s ability to stay enrolled on a parent’s private health insurance until they turn 26; and
    • Rolling back important protections for people who access reproductive health services, as well as anti-discrimination protections for members of the LGBTQ+ community, particularly trans individuals.
  • The Health Care Repeal Lawsuit is a threat to our nation’s health care system, and several potential outcomes would have serious and long-lasting consequences for millions of people.

What can we do?

We need people to prepare now for several potential outcomes. No matter the ruling, the fight to preserve the ACA is far from over. While it’s easy to feel helpless about judicial proceedings, there are concrete actions you can take:

  • Hold the president and the DOJ accountable for this lawsuit.
  • Urge your senator to publicly ask the U.S. Senate to become an intervener in the lawsuit, similar to action the U.S. House took earlier this year.
  • Call or write your attorney general to demand they withdraw from the plaintiffs’ side if they had previously signed on to strike down the ACA.
  • Thank your champions! If you have a senator, representative, governor or attorney general that has spoken out in favor of the ACA and against the Health Care Repeal Lawsuit, please thank them for their support.
  • Identify state and local government officials (e.g., mayors and county commissioners) who may be willing to publicly support the ACA.
  • You can ask your state government to analyze what effects an ACA repeal would have on your state’s health care and economy.

Beyond these concrete actions, the Health Care Repeal Lawsuit (Texas v. U.S.) has actually given us a powerful tool to highlight the work currently underway to increase quality of care and access to coverage.

Despite this pending lawsuit that aims to take away the health care of millions, the House stepped in to defend the case and passed bills (in the House, only) to protect pre-existing conditions and strengthen the ACA.

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