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Fifth Circuit Court Of Appeals Rules ACA Individual Mandate Unconstitutional


First, to news of a highly anticipated court ruling on the future of the Affordable Care Act. Two judges in the 5th Circuit Court of Appeals in New Orleans found that the individual mandate is unconstitutional but stopped short of saying that the whole law is invalid. This is a complicated decision, and NPR health policy reporter Selena Simmons-Duffin is here to explain it.

Hi, Selena.


SHAPIRO: There have been a lot of court cases about the Affordable Care Act. Remind us - what is this one?

SIMMONS-DUFFIN: So this one is called Texas v. Azar. If you remember back to 2017 when Republicans in Congress were trying to repeal and replace the Affordable Care Act again and again - finally, in December of that year, they passed a tax bill. And in that bill, they zeroed out the penalty for not having health insurance.

SHAPIRO: And that penalty for not having health insurance was the reason that the Supreme Court upheld the Affordable Care Act.

SIMMONS-DUFFIN: Exactly. Right. So this challenge is Texas and some other states saying a zero-dollar penalty is not a constitutional tax, and therefore, the individual mandate is unconstitutional. And because it was central to the Affordable Care Act, the whole law is unconstitutional. So what happened last year is a district judge in Texas said that that whole argument was correct. And this is the appeal of that decision.

SHAPIRO: OK. So the district court judge says the whole Affordable Care Act is unconstitutional. The 5th Circuit appeals court hears oral arguments in July. And today we get this decision. What does it say?

SIMMONS-DUFFIN: So this decision says, yes, the zero-dollar penalty is unconstitutional. But when it comes to whether it can be cut off from the rest of the law, they kind of punted. They sent it back to the district judge and said, do more analysis on this.

SHAPIRO: Well, what does this mean for the future of the law and for this case specifically?

SIMMONS-DUFFIN: So right now, what it means for the law is that it's still in place.


SIMMONS-DUFFIN: Nobody should panic about what happens to their health insurance. What it means for the case is that there's probably a long legal road ahead. The California state attorney general, which is on the defending side of the law, has already said that they're prepared to defend the case and to, you know, appeal it up. That probably means it'll end up, again, before the Supreme Court. This would be the third case the Supreme Court would hear on whether the ACA is constitutional.

SHAPIRO: Yeah, and potentially in an election year, which is significant.

SIMMONS-DUFFIN: Exactly. So as you say, there are political consequences to this ruling coming out today, too. President Trump has come out and said in a decision, this decision will - he said in a statement, this decision will not alter the current health care system. My administration continues to work to provide access to high-quality health care at a price you can afford, while strongly protecting those with preexisting conditions.

So you see, this presents a little bit of a problem for the Trump administration because it raises the specter of 20 million people possibly losing their health care coverage, which is kind of a dicey place to be in. And it also brings into relief the fact that the Trump administration has yet to come out with a plan for what would replace the Affordable Care Act if, ultimately, the Supreme Court comes back and says, actually, the third time we hear this, the law is unconstitutional.

SHAPIRO: That is NPR health policy reporter Selena Simmons-Duffin on one of two major breaking stories...


SHAPIRO: ...That we are covering this evening.

Thank you, Selena.

SIMMONS-DUFFIN: Thank you. Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.