The ACA is now embedded in U.S. health care — and its legality is still in question


JOHN YANG: Since its creation, there has been
no letup in the fight over Obamacare. As William Brangham reports, a federal appeals
court has likely ensured it will be an issue in the 2020 campaign and beyond. WILLIAM BRANGHAM: That’s right, John. A federal appeals court struck down the individual
insurance mandate. It was a key part of the Affordable Care Act. But the court avoided making a broader decision
on whether, in the absence of the individual mandate, the entire law should be invalidated. Instead, the judges kicked it back to a lower
court in Texas to look at that question again. Most observers believe Obamacare will eventually
make its way back to the Supreme Court for a third time, but likely not before the coming
presidential election. Julie Rovner of Kaiser Health News is here
to help us understand what this all means. So, what does all of this mean? The court says, OK, the mandate is a no-go. What does this mean? JULIE ROVNER, Kaiser Health News: Well, what
it means now for people who are covered under the federal health law is not very much, because
everybody says that it will continue to be enforced until this is resolved. Basically, what it does, though is, as you
say, it creates a lot more uncertainty for the law. It is possible that the law could be struck
down in part or in its entirety. What the judge basically found — that the
lower court judge had found is that, when Congress changed the law in the 2017 tax bill,
it reduced the penalty for not having insurance to zero. What the Republican attorneys general who
brought the suit argued was that, without that penalty, it was no longer a tax and,
therefore, it was no longer constitutional, because that’s how it was found constitutional
in 2012, and, therefore, this part is unconstitutional. The lower court judge said, if this part is
unconstitutional, the whole law is unconstitutional, too. This court said, we’re not sure about that. You go back, lower court judge, and do a more
careful review of what might be allowed to stay and what would have to go. WILLIAM BRANGHAM: Remind us again just that
— this obviously cast a huge cloud of uncertainty over the law itself, but it’s not just the
20 million people who rely on getting their insurance directly through the ACA, right? JULIE ROVNER: That’s right. The ACA has touched all parts of the U.S.
health care system. Yes, it’s directly responsible for about 20
million people who buy their own insurance through the marketplaces or who get the expanded
Medicaid coverage. But it also creates a lot of new benefits
for people on Medicare, for people on Medicaid. For people with private insurance, now their
adult children can stay on their health plans, they can get free preventive care. So there are lots of pieces of the health
law that are now embedded into the health system. If you tried to take it away, you could make
a big mess. WILLIAM BRANGHAM: So we’re waiting to see
what this court in Texas does. Meanwhile, the attorney general of California
is part of this multistate sort of protection effort to try to keep the ACA intact. They’re trying to push this through the Supreme
Court quickly. Right? Explain what is going on in that. JULIE ROVNER: That’s right. This is Attorney General Xavier Becerra from
California, who said last night that he planned to go straight to the Supreme Court. It’s not a sure thing that the Supreme Court
would take this case at this point, because it hasn’t finished in the lower courts. But what he’s going to argue is that this
uncertainty is untenable and that the court really does need to take it up right away. And it is possible for the court to take it
up right away, perhaps as soon as before the election, although that would seem to be kind
of a long shot. WILLIAM BRANGHAM: So the idea, is, though,
if they think that they have a better shot in the Supreme Court now, because is Supreme
Court thus for has, for the most part, upheld the ACA? JULIE ROVNER: Well, there are the four, you
know, liberal justices who they clearly would have and then John Roberts, of course, is
the one who has upheld the law twice now. He was the deciding vote in the 2012 case,
who said that, because it’s a tax, that it’s constitutional. So I think they’re betting that maybe they
would get the four liberals and John Roberts. And who knows, if they wait a couple of years,
what the court will look like. WILLIAM BRANGHAM: One of the reasons we love
talking to you is because the policy so well, but you also know the politics of all of this. This certainly seems to force this right back
into the presidential election. How do you think this shakes out? Is this a positive for the Republicans or
the Democrats, or both? JULIE ROVNER: It’s a little bit of a draw. Had the judge agreed fully with the lower
court judge and said that the entire law is unconstitutional, then I think the Republicans
would have had a big problem, even though it wouldn’t have taken effect until it goes
to the Supreme Court. That would have been a much easier case for
the Democrats to make that Republicans are trying to get rid of this law. They can still make that case, to some extent,
but this is a little bit muddier. I think it will still be an issue going into
the general election, though, regardless of whether the Supreme Court has this case before
it this year. WILLIAM BRANGHAM: We certainly are seeing
the Democrats debating not just the protection of the Affordable Care Act, but the expansion
thereof. Let’s turn to another issue, which is this
— the concern over the high cost of prescription drugs. The HHS secretary just announced that they
are going to start allowing states and some pharmacies and some other groups to import
drugs from Canada. What is this? What’s the proposal and what’s the idea? JULIE ROVNER: This is a 20-year fight. And it’s been bipartisan the whole time. Republicans — some Republicans have wanted
to do it. Some Democrats wanted to do it. The idea is to basically import other countries’
price controls. You get cheaper drugs from countries that
have price controls. Bipartisan commissioners of the Food and Drug
Administration have said, not safe. We don’t really know where these drugs come
from. If you go into a pharmacy in Canada and buy
drugs, it’s going to be safe. But if you’re importing it through the mail,
you don’t really know what you’re getting. This is the first time in administration has
said, we’re going to see if we can try this. But it’s very early. It’s not clear whether Canada would go along
with this and allow their drugs to be… WILLIAM BRANGHAM: They not so eager, necessarily,
to be our drugstore. (LAUGHTER) JULIE ROVNER: They are not. They don’t have enough drugs to supply the
United States. So it — but it’s definitely one of those
issues that both sides are trying to court voters on. And drug prices are a big political issue
going into 2020. WILLIAM BRANGHAM: Is it a function of simply
courting voters? Or is this, realistically, going to be meaning
cheaper drugs for people soon? JULIE ROVNER: If you could make it work, but,
obviously, there are not enough drugs in Canada to supply the United States. We’re a much larger country. WILLIAM BRANGHAM: So I have heard. Julie Rovner of Kaiser Health News, thank
you. JULIE ROVNER: Thank you.

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