Supporters of the Affordable Care Act in Maryland said Thursday they were disappointed but not surprised by a federal appeals court’s ruling against the law a day earlier. They vowed to continue their efforts to enshrine as many of the ACA’s provisions into state law as they can, and to do so as quickly as they can, in the event the Supreme Court delivers the ultimate death blow.
The 2-1 ruling on Wednesday, by a panel of the United States Court of Appeals for the Fifth Circuit in New Orleans, was a victory for the 18 state attorneys general — all from red states — who argued that “Obamacare” is unconstitutional.
The challengers argued successfully that — although the Supreme Court upheld the ACA in 2012 — circumstances changed in 2017 when Congress removed the individual mandate to purchase health insurance. (The “mandate” was actually a tax on uninsured persons who failed to purchase coverage.)
In an interview, Sen. Brian J. Feldman (D-Montgomery), a leader in efforts to promote health care reform in Annapolis, noted that Maryland was the first state in the nation to create a Health Insurance Coverage Protection Commission, out of “concern about the ultimate dismantling of the Affordable Care Act and how were we going to respond.”
Feldman said the ruling, which sends the case back to a lower court, means “continued uncertainty about the future and the fate of the Affordable Care Act,” with policymakers and consumers left to guess what the law’s ultimate fate will be, or when a final judgement will arrive.
“There’s uncertainty in the marketplace. There’s uncertainty with folks who want to know what it means for them in terms of their health insurance. There are several parts of this that are complicated,” he said.
Maryland lawmakers will again consider legislation that requires insurance policies to cover pre-existing conditions. Another 2020 bill would require that young adults be allowed to remain on their parents’ plans until they turn 26. Both provisions are popular features of “Obamacare.”
The state has already enacted an “Easy Enrollment” feature that has the potential to identify uninsured residents who are eligible for free or low-cost coverage, using state tax forms, another innovation that other states are studying. That provisions is kicking off in the new year.
But concern doesn’t end with the potential loss of Obama-era reforms.
Feldman also worries that billions of dollars in federal aid will be lost if the Supreme Court — which has a different makeup than it did when it upheld Obamacare seven years ago — strikes the entire law down.
“There’s the Medicaid expansion parts of the Affordable Care Act. There’s the premium tax subsidies that help lower-income people purchase health insurance. If the entire Affordable Care Act is ruled unconstitutional, then all those monies related to the ACA also go away,” he said.
Feldman said an estimated 300,000 Marylanders would lose coverage if that were to occur.
Texas vs. U.S. is not expected to reach the Supreme Court until 2021 at the earliest.
Vincent DeMarco, president of the pro-reform Maryland Citizens Health Initiative, called the ruling “extremely disappointing” and said it “puts at risk life-saving health care coverage to millions of Americans.”
U.S. Sen. Benjamin L. Cardin (D-Md.), a member of the Finance Committee’s Health Care Subcommittee, suggested that Republicans are trying to dismantle the nation’s health care system.
“Republicans want to destroy our health care system rather than fix it,” he said. “Today they are closer to achieving their mission.”
Cardin predicted that the GOP could face political consequences.
“Republicans will be directly responsible for the any coming spikes in costs for millions of middle income families and any loss of the many patient protections guaranteed by the ACA,” he said.