• Analysis or Summary
  • March 28, 2019

Implications for Children of TX ACA Court Ruling

On Dec. 14, 2018, the Texas Federal District Court issued a ruling which found that the 2017 repeal of the tax penalty related to the individual mandate under the Affordable Care Act (ACA) renders the individual mandate and, as a result, the entire law unconstitutional. The court ruling will have no immediate legal effect on the ACA and has been appealed to the U.S. Court of Appeals for the Fifth Circuit by seventeen Democratic attorneys general.

On March 25, the U.S. Department of Justice (DOJ) sent a letter to the U.S. Court of Appeals asserting that the entire ACA should be found unconstitutional. The DOJ had previously taken the position that the law's prohibition against medical underwriting and its guaranteed issue protection are unconstitutional, but that the rest of the ACA should be upheld. Arguments could be made in mid-to-late 2019 and a decision in late 2019 or early 2020. In the event the case goes to the Supreme Court, a final decision is not expected before the middle of 2021.

This CHA backgrounder provides an overview of the case and includes a detailed list of all provisions of the ACA related to children's health and children's hospitals that could be repealed if the ACA is ultimately overturned. The list includes, among others, provisions related to:

  • Children's Coverage
  • Medicaid Disproportionate Share Hospital Payments
  • Health Care Workforce and Capacity Building
  • 340B Drug Pricing Program
  • Charitable Hospital Requirements
  • Price Transparency
  • Quality Measurement and Quality Improvement
  • Public Health
  • Innovative Medical Therapies