Danella Cheslow wrote that the Affordable Care Act faces a new legal challenge after a federal judge in Texas ruled the law unconstitutional on Friday. The decision risks throwing the nation’s health care system into turmoil should it be upheld on appeal. But little will be different in the meantime.

“Nothing changes for now,” says Julie Rovner, chief Washington correspondent of Kaiser Health News.

“If you need to sign up for health insurance you should,” Rovner tells NPR’s Michel Martin. “If you’re in one of the several states where it’s extended where you can sign up through January, you have time to do that too.”

Below are some questions and answers about the ACA.

1. What was the Texas ruling?

U.S. District Judge Reed O’Connor ruled that the Affordable Care Act was not constitutional. O’Connor made his decision after 18 Republican state attorneys general and two GOP governors brought their case, Rovner reports. They claimed that the Supreme Court upheld the ACA in 2012 because it included an individual mandate — or a tax penalty for Americans who did not buy health insurance. After Congress repealed the individual mandate in 2017, O’Connor said the rest of the law fell apart.

2. Who might this ruling affect?

The Affordable Care Act runs for more than 1,000 pages and includes many provisions — the exchanges for individuals that are frequently political footballs — and a long list of other measures and protections designed to expand insurance coverage.

NPR’s Alison Kodjak reports that the ACA expanded Medicaid, which has allowed more than 10 million people to get coverage in states that chose to expand the program. The law also protects people with pre-existing conditions and allows people up to age 26 to be covered under their parents’ insurance; requires calorie counts at restaurants and gives protections to lactating mothers. The ACA also secured more money for Native American health care and made significant changes to allow for generic drugs and to provide funding for Medicare.

Rovner says people should act as if the ACA is still in place, but the ruling opens a possibility for “an enormous disruption.”

“It would really plunge the nation’s health care system into chaos,” Rovner says. “The federal government wouldn’t be able to pay for Medicare because all the Medicare payments have been structured because of the Affordable Care Act.”

3. What next?

Judge O’Connor did not rule the law has to be enjoined immediately. Saturday was the last day of open enrollment for the ACA in most states. NPR’s Kodjak reports people can still enroll in health plans in states with extended deadlines. She says even the newest ACA insurance policies will go into effect until more legal action plays out in courts. The federal site for insurance, Healthcare.gov, is running a banner that reads, “Court’s decision does not affect 2019 enrollment coverage.”

NPR’s Kodjak says the state of California has already said it will appeal the ruling. Other states will likely join California in the fight to preserve the law, Kodjak reports. Rovner says the case will probably reach the Supreme Court, though lower courts may reject O’Conner’s ruling first.

4. What are the political stakes in this decision?

The political stakes are great. Voters saw health care as an important issue in November’s midterm elections. Kodjak notes Congress voted multiple times in 2017 to repeal the ACA but did not succeed.

“Lots of Republicans were running ads during the midterms saying they were the ones who were going to protect people’s health care, and specifically protect people with pre-existing conditions,” Kodjak says.

The challenge to the ACA brought by Republican attorneys general is aimed at eliminating protections for pre-existing conditions, Kodjak says.

“So now you have Republicans trying to play both sides, which is going to be difficult,” she says.

Attorneys general seek clarification from judge on ACA ruling

Pearl of the New York Times looked at the ACA ruling and the reports states supporting the ACA asked Judge Reed O’Connor of the Federal District Court in Fort Worth, “to protect current health care coverage for millions of Americans while courts sort out the implications of his ruling that the Affordable Care Act was invalid in its entirety.” The states warned that their citizens would face “devastating harm from the invalidation” of the ACA. HHS spokeswoman Caitlin Oakley “said Monday that because Judge O’Connor had not issued a final judgment or an injunction, the department ‘will continue administering and enforcing all aspects of the A.C.A. as it had before the court issued its decision.’”

Also, De Vogue, Luhby of CHH, reports that  California Attorney General Xavier Becerra also asked the court to take the legal steps necessary to allow the states to appeal the decision “expeditiously.” HHS said in a statement, “This decision does not require that HHS make any changes to any of the ACA programs it administers or its enforcement of any portion of the ACA at this time,” but added, “as always, the Trump administration stands ready to work with Congress on policy solutions that will deliver more insurance choices, better healthcare, and lower costs while continuing to protect individuals with pre-existing conditions.”

Why some conservatives don’t like the ruling against ObamaCare

Howard Kurtz of Fox News noted  that Conservatives who have long despised ObamaCare might be expected to rejoice now that a federal judge in Texas has ruled the law unconstitutional.

But few of them are popping champagne corks, at least in the media.

“No one opposes ObamaCare more than we do,” says The Wall Street Journal’s editorial page, but the ruling “is likely to be overturned on appeal and may boomerang politically on Republicans.”

ObamaCare was a “misbegotten law,” says National Review. “Yet we cannot applaud Judge Reed O’Connor’s decision. Indeed, we deplore it. It will not lead to the replacement of Obamacare, as much as we desire that outcome. It will instead give Republicans another opportunity to dodge their responsibility to advance legislation toward that end … it is very likely to be overturned on appeal because it deserves to be.”

ObamaCare coverage remains intact amid federal court ruling

.I have stated before that ObamaCare was flawed  legislation, to say the least, that drove up premiums for some people and, despite the former president’s promises, caused others to lose their doctors and their plans.

But there’s a reason that a Republican Congress, with President Trump’s backing, failed in three attempts to repeal and replace the law. Much of the GOP didn’t want to take the political heat for causing millions of Americans to lose their health insurance.

The law has become more popular now that its namesake is out of office, and especially the provision that bars insurance companies from rejecting people with preexisting conditions. Many Republicans spent the campaign vowing to preserve that part of the law (even some who had voted to abolish ObamaCare or moved to weaken it at the state level).

Not everyone on the right agrees. The Federalist says the judge’s ruling is overdue because “the blunt reality that Obamacare was always at heart a bad-faith proposition. The basic operation of the law, never stated or acknowledged by its authors, was to force younger, healthier people to subsidize health insurance for older, sicker people. It was a redistribution scheme, plain and simple.”

By the way, it’s no coincidence that the decision came from O’Connor, a controversial and conservative Bush appointee who frequently ruled against the Obama administration. Nor is it happenstance that the states that filed the suit did so in Texas, where the courts are more conservative — the flip side of Trump complaining about lawsuits in the liberal 9th District in San Francisco.

When the John Roberts court upheld the law in 2012, it said Congress couldn’t force people to buy insurance through the individual mandate, but that was okay because it could tax people for not buying coverage.

What’s next for ObamaCare after Texas judge’s ruling?

Last year, as part of tax reform, Congress set the penalty tax at zero, effectively eliminating the mandate. O’Connor ruled that the whole law must be tossed out because it’s based on a tax-slash-mandate that no longer exists.

It’s doubtful that the Supreme Court will buy this argument, but the political impact, in the short term, is clear. Democrats see a boost in their effort to pass some version of Medicare for All, although the ruling should freeze things and the GOP Senate won’t go along in any event. Republicans have to navigate a path between rhetorical opposition to ObamaCare and not taking steps that would cause a health care crisis and blow up the preexisting conditions ban.

Trump, while tweeting that the law is an “UNCONSTITUTIONAL DISASTER,” was quick to add: “Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”

But getting it done would have been easier when Nancy was minority leader. Ultimately, a divided Congress, not the courts, must figure out a way out of this mess.

Obamacare unconstitutional? That’s a cruel mistake, not ‘great news for America’

Opinion’s Andy Slavitt noted that President Donald Trump apparently hasn’t had enough of the health care fueled butt-kicking handed to him and his party in the midterm elections. He heralded as “Great news for America!” a ruling from a Texas judge Friday that found the entire Affordable Care Act unconstitutional. Once again, Trump and Republicans have put taking away health care at the top of the agenda, this time for the 2020 presidential election.

Let’s look at what this ruling would do if it were allowed to stand. What part would be great for America, as Trump claims?

Seventeen million people would lose their coverage in a single year. Not great.

Americans with pre-existing conditions — as many as 130 million — would lose the law’s protections against unaffordable insurance policies and denials of coverage. This was not a small issue in the midterms. Also not great.

The expansion of Medicaid to more low-income families would end  — causing real damage to millions of people, states and community hospitals that have made so much progress since it passed. Again, not great.

Insurance companies would no longer have to offer coverage of kids up to age 26 on their parents’ plan. Annual and lifetime limits would be back. Women and people over 50 would see higher prices and discrimination would be legal again. Is that great?

The closing of the Medicare prescription drug coverage gap (the “donut hole”), which has saved seniors thousands of dollars on their medications, would be gone. Is it great, yet?

Which part, Mr. Trump, is the great part, other than the opportunity for you to send out a nasty tweet and put people in agony?

Republicans in Congress, starting with Senate Majority Leader Mitch McConnell, have defended this lawsuit even as Republican candidates all over the country “pledged” their support for pre-existing condition protections during the midterms. Now that those campaign ads are over, we get to see them wink at the camera.

Make no mistake, with few exceptions, this is a ruling supported by the near entirety of the Republican Party — from Trump to congressional leaders to governors and state attorneys general. It’s their dream come true.

Even conservatives say ACA ruling won’t stand and I am in agreement.

The part of “repeal and replace” Republicans never liked was the “replace” part. The Republican health care position is to let insurance companies charge as much as they like and cover as little as they like.

They voted to kill or sabotage the ACA over 70 times with no replacement, and their preferred approach after Trump was elected was “repeal and delay.” Now a judge in Texas would deliver all that Republicans couldn’t deliver in Congress, and more.

Politically, Republicans may try to use the ruling to try to get Democrats to compromise their principles and bait them into supporting some weak cover story of a health care bill. Democrats, and likely House Speaker Nancy Pelosi, won’t bite. To most Americans, the ACA doesn’t go far enough and Democrats know that.

Conservative legal scholar Jonathan Adler, no ACA supporter, calls the Texas judge’s ruling “weak,” “insane” and so full of legal holes that appellate court judges and even the more conservative Supreme Court wouldn’t support it.

Fortunately, one judge in Texas doesn’t get to undo the Affordable Care Act. The case will make its way through the courts and has the potential to end up in Chief Justice John Roberts’ Supreme Court in 2020 during the throes of an election year.

By pushing this through the courts, Trump has now ensured that this deeply unpopular GOP position to strip away pre-existing condition coverage will stay in the news. These reminders will be loud enough to break through all the other noise and turn the 2020 election into yet another referendum on health care, even on top of the growing list of serious crimes in which the president is implicated.

GOP is inflicting nonstop terror on Americans

Even if this case goes nowhere, as most observers expect, it causes damage. Trump and the Republicans are inflicting a kind of nonstop terror on the American public. Year after year, millions of people wonder whether eventually, by hook or by crook, Republicans will succeed in overturning the ACA and the coverage and protections they rely on.

Sleepless nights are supposed to be reserved for crying babies, not wondering if your own government will pull the rug out from under you. There are many pundits and experts reacting to this news, but it’s the real people in communities across the country who now face more years of uncertainty.

Alison Chandra, whose son Ethan was born with a rare genetic disorder, spoke for many in an interview on CNN. She sees this case as “the continuation of a nightmare.” She lamented that the president, in his tweet, “celebrated the fact that so many of the most vulnerable potentially will not be able to access life-saving care.”

It’s what Allison said next, as she held 4-year old Ethan on her lap, calmly looked at the camera and considered Trump celebrating her uncertainty, which should haunt Trump and his party: “And I will never forget that.” Trump is making sure of it.

But the Dems are also inflicting nonstop terror as they now blame everything wrong with the present healthcare system, as well as everything else on the GOP and orf course, President Trump.

5 Ways Nixing The Affordable Care Act Could Upend U.S. Health System

Julie Rovner noted that if last Friday’s district court ruling that the Affordable Care Act is unconstitutional were to be upheld, far more than the law’s most high-profile provisions would be at stake.

In fact, canceling the law in full — as Judge Reed O’Connor in Fort Worth, Texas, ordered in his 55-page decision — could thrust the entire health care system into chaos.

“To erase a law that is so interwoven into the health care system blows up every part of it,” says Sara Rosenbaum, a health law professor at the George Washington University School of Public Health. “In law they have names for these — they are called super statutes,” she says. “And [the ACA] is a superstatute. It has changed everything about how we get health care.” (That concept was developed by Abbe Gluck, a professor at Yale Law School.)

O’Connor’s decision is a long way from implementation. He still must rule on several other aspects of the suit brought by 18 Republican attorneys general and two GOP governors. And a group of state Democratic attorneys general has promised to appeal O’Connor’s decision, which would send it to the 5th Circuit Court of Appeals and, possibly, the U.S. Supreme Court. The high court has rejected two previous efforts, in 2012 and 2015, to find the law unconstitutional.

Meanwhile, here are five ways that eliminating the ACA could upend health care for many, if not most, Americans:

Millions could lose coverage directly

More than 20 million Americans who previously were uninsured gained coverage from 2010 to 2017. Some of that was due to an improving economy, but many also gained the ability to buy their own coverage, thanks to the law’s federal subsidies to defray the cost of insurance. Other provisions of the Affordable Care Act played a significant role, including its ban on restrictions for people with pre-existing medical conditions, expansion of the Medicaid program to more low-income adults and allowing adult children to stay on their parents’ health plans until reaching age 26.

If the law were reversed, federal funding for Medicaid and individual insurance subsidies would stop, and insurers could once again refuse coverage to or charge more for people who have health problems.

Fundamental changes to the health care system could be stymied

The impact of eliminating the ACA could be felt well beyond those people who are the direct beneficiaries of the law.

Gail Wilensky, who ran the Medicare and Medicaid programs under President George H.W. Bush, says such a change “would be very disruptive because so much [of the ACA] has affected the way health care is organized and delivered, and the way insurance is provided.”

For example, says Rosenbaum, the increase in health coverage meant that “suddenly it became possible for health care systems to care for, by and large, an insured population.”

Previously many hospitals, doctors and other health providers spent considerable time and effort figuring out how to treat — without going broke —people who lack insurance.

After the ACA kicked in, these providers began to worry less about whether they would get paid. And the federal government started pushing them to create new initiatives aimed at improving the quality of care.

Those include, for example, measures that base some federal payments on patients’ health outcomes rather than on each individual procedure performed. Under the ACA, the government also encouraged strategies that improve health across the U.S. — like improving the availability of healthful food, bicycle paths and preventive care.

If millions of people lost insurance, Rosenbaum says, those health providers “would have to go back to wondering how they will be able to pay their bills.”

Medicare and Medicaid would be dramatically altered

The popular Medicare program, which covers an estimated 60 million seniors and people with disabilities, was a major focus of the ACA.

Elimination of the federal health law would take away some popular benefits the ACA conferred — everything from free preventive care to the closing of the “doughnut hole” in Medicare’s prescription drug coverage. The doughnut hole refers to a coverage gap that had previously exposed large numbers of beneficiaries to thousands of dollars in drug costs.

The law also changed the way Medicare paid for hospital, home health and outpatient care. Many current payment policies are based on authority provided by the ACA, and if it went away, Medicare would have to rewrite those payment regulations. Millions of beneficiaries belong to accountable care organizations that were created under the health law, and it is unclear how their care would be affected.

The biggest change in the Medicaid program would be the elimination of the expansion of coverage. Loss of the ACA would also roll back a 23-percentage-point boost in Medicaid prescription drug rebates, which has saved states billions of dollars, according to Cindy Mann. She ran Medicaid under President Barack Obama and is now a partner at the health consulting firm Manatt Health.

The ACA required states to calculate Medicaid eligibility differently — changing what counts as income — so all the work states did to alter their information systems would have to be recalculated, she says.

Wide array of health programs at risk

Shorthand descriptions of the health law often stop at its provisions providing consumer protections and expanding Medicaid. But the ACA included sweeping changes to other parts of the health system that rarely get mentioned.

For example, it created the first pathway for Food and Drug Administration approval of generic copies of expensive biologic drugs, by incorporating the Biologics Price Competition and Innovation Act of 2009. Biologic drugs are more difficult to reproduce than other types of medications.

Also hitching a ride on the ACA was a long-delayed bill providing permanent spending authority for programs provided by the Indian Health Service, which serves Native Americans.

And the law included a series of grant programs to help train more health professionals who would be needed to treat the millions of newly insured Americans.

All those programs would be thrust into doubt by invalidating the law.

Loss of the ACA also would impact a popular program that predates Obamacare: the Health Insurance Portability and Accountability Act, or HIPAA.

The ACA’s protections for pre-existing conditions — banning insurers from charging people with health problems higher premiums or refusing to sell to them altogether — built on similar protections for people with employer insurance. Congress included those protections in HIPAA, which was enacted in 1996. And far more people are touched by HIPAA than by the ACA, because far more people get health insurance through their employer than through the individual market.

However, when Congress wrote the ACA, it incorporated HIPAA safeguards into the pre-existing-condition provision. That means if the ACA is struck down, the HIPAA protections might disappear as well.

Even the Trump administration’s health agenda could be compromised

President Trump has railed against the health law, but his Department of Health and Human Services has a priority list that relies in some significant ways on the continued existence of the ACA.

For example, efforts to address the opioid epidemic — one of the administration’s top health challenges — could be seriously set back if the Medicaid expansion were to end. Medicaid is the largest single payer for mental health and substance abuse treatments.

Much of the president’s effort to limit drug prices flows through the Center for Medicare & Medicaid Innovation, which was created by the ACA and would lose its legal authority if the law became invalid.

Similarly, the administration is using this center to pursue “bundling” payments for certain surgical procedures — an effort to try to get more value for dollars spent.

I’m not sure that any of this all matters because for the next 2 years the Democrats are going to impeach or indict President Trump and if nothing else make him and the GOP look like a bunch of incompetent boobs not worth an additional term on office. So, get ready for a contentious 2 years or more unless someone or groups of the Congress put on their grownup pants and realize that they were voted in by the voters, their employers who expect improvement in our economy, our environment, our healthcare and our country.

Oh, and more importantly Merry Christmas and Hopes and Wishes for a great successful New Year. My hope is that during this busy Holiday season, I hope that you all will find time to rekindle old acquaintances, renew and strengthen bonds with family and friends and reflect on the past year as we all wish and hope for an even better year to come despite the incivility and  anger pervasive in our country.

Ho, Ho, Ho!!