• Analysis or Summary
  • December 20, 2019

Implications for Children of ACA Constitutionality Case

On Dec. 18, the Fifth Circuit Court of Appeals ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional, but sent the remainder of the pending lawsuit, Texas v. U.S., back to the lower court for further review and analysis. The ruling is the latest court action following a Dec.14, 2018 finding by Texas Federal District Court Judge Reed O’Connor that the 2017 congressional repeal of the tax penalty related to the individual mandate renders the individual mandate and, as a result, the entire law unconstitutional. O’Connor reasoned that both the individual mandate and the tax penalty are integral to the ACA and not severable from the remainder of the law. 

In its 2-1 decision, the Court of Appeals agreed with O’Connor about the individual mandate but did not take a position on the implications for the remainder of the ACA, sending the severability issues back to the lower court for further review. While it is unclear how long the review might take and the next steps in the court system, for now, the entire ACA remains in effect, albeit without the individual mandate. 

This CHA backgrounder provides a detailed list of all provisions of the ACA related to children's health and children's hospitals that could be repealed if the ACA is ultimately overturned.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