Obamacare's 'essential benefits' explained

Under Obamacare, all insurance providers have to ensure a minimum level of coverage. CNN Chief Medical Correspondent Dr. Sanjay Gupta reports.

Posted: Dec 16, 2018 8:52 PM
Updated: Dec 16, 2018 8:59 PM

Late on Friday, a federal district judge in Texas, Reed O'Connor, dropped a bomb on the Affordable Care Act, and indeed on the entire American health care system.

His ruling, in Texas v. U.S., was a victory for the 20 Republican state attorneys general and governors who had brought the case in February, asking the court to block operation of the health care law. They based their attack on the law's requirement that people either buy health insurance or pay a penalty, which opponents of the law have long called an unconstitutional mandate.

In a landmark decision in 2012, the Supreme Court upheld the law by declaring that mandate was actually a tax, which Congress had the authority to impose. But when Congress reduced the tax to zero last year, the plaintiffs argued that now -- without its individual-responsibility enforcement mechanism -- the entire Affordable Care Act was suddenly unconstitutional.

Judge O'Connor agreed. He said further that the law and its mandate could not be separated, and with this key part missing, the whole law should collapse, like a pillar of blocks in the game Jenga.

The scope of Judge O'Connor's judgment is breathtaking. The ACA contains ten titles and hundreds of individual provisions governing every corner of our health care system. The invalidation of the ACA, if upheld on appeal, would affect virtually every American.

Of course, millions of individuals who purchase their insurance directly from insurers or through the marketplaces would lose the ACA's preexisting condition protections. Older Americans and women could again be discriminated against as well.

Millions of individuals and families covered through the ACA's Medicaid expansions would lose coverage — even in states that have recently passed referenda to expand coverage — but other Medicaid beneficiaries would lose benefits conferred by the ACA as well.

Medicare beneficiaries would lose preventive-services coverage and could see the "donut hole" reopen, imposing higher drug costs. Indeed, the order may invalidate current ACA regulations governing Medicare payments, throwing the Medicare program into chaos.

Most Americans, who have coverage through their employer, would lose their right to preventive services and coverage of children to age 26 and see lifetime and annual dollar limits of coverage reappear. ACA reforms to the Indian Health Service or provisions for FDA approval of generic biologic drugs would disappear. Fraud and abuse protections included in the ACA would no longer be effective.

In deciding to wreak this destruction on the American health care system, Judge O'Connor arrogated to himself authority that rightly belongs with Congress. A Republican Congress spent most of 2017 debating to what extent it wanted to repeal the ACA. In the end, it only changed one small provision: reducing the shared responsibility tax to $0.

Judge O'Connor believes that in doing so, Congress pulled a grenade pin, exploding the entire law. But numerous Republicans, both during the debate on the vote on the tax law and since, have made it clear that was not what they did.

Judge O'Connor points to the "findings" from the original ACA itself to claim that the mandate was "essential" to various provisions of the law, but those findings were included to bolster arguments that the mandate was constitutional as a legal requirement and were not intended to make the rest of the law dependent on the mandate.

Republicans in Congress repeatedly tried and failed to repeal the ACA. It is not up to an unelected judge to do it himself.

So, what does Judge O'Connor's judgment mean? He specifically did not enter an order blocking the operation of the law, so it remains in effect. O'Connor only found two individuals had standing to challenge the law, so arguably the ruling only applies to them.

Another judge is considering a case brought by Maryland to uphold the ACA, so we may get dueling judgments. An earlier appellate court decision, involving a number of the states in this case, invalidated the individual mandate but held the entire remainder of the ACA to be valid. Any noncompliance with the law may be challenged in other courts.

California will appeal Judge O'Connor's decision and the Trump administration may appeal parts of it as well. It will likely be reversed on appeal and may never get to the Supreme Court. It is simply the opinion of one district court judge.

But it will surely cause chaos and confusion throughout the health care system, as the federal government's lawyer predicted at oral arguments. No doubt that is what Judge O'Connor wanted.

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 443562

Reported Deaths: 5918
CountyCasesDeaths
Hennepin921721468
Ramsey39534730
Dakota32680325
Anoka30733358
Washington19904223
Stearns17728184
St. Louis13503239
Scott1185394
Wright11519102
Olmsted1031671
Sherburne813664
Carver689336
Clay646678
Rice597866
Kandiyohi551571
Blue Earth536333
Crow Wing478173
Otter Tail451362
Chisago447932
Benton416085
Winona384546
Douglas371566
Nobles366346
Mower360127
Goodhue342857
Polk327056
McLeod322244
Morrison309343
Beltrami307446
Lyon299035
Itasca281543
Becker280638
Isanti280640
Carlton278042
Steele27019
Pine264413
Freeborn238720
Todd230529
Nicollet222636
Brown212634
Mille Lacs212145
Le Sueur207615
Cass204723
Meeker198233
Waseca188015
Martin168826
Wabasha16802
Roseau165216
Hubbard147638
Redwood138827
Renville136339
Houston133613
Dodge13244
Chippewa130732
Cottonwood125618
Fillmore12135
Wadena118214
Rock109412
Sibley10767
Aitkin106733
Watonwan10598
Faribault103814
Kanabec96818
Pennington96715
Pipestone93423
Yellow Medicine92614
Murray8625
Jackson85010
Swift83017
Pope7355
Marshall70115
Stevens6968
Clearwater68314
Lac qui Parle65416
Lake62615
Wilkin6219
Koochiching58410
Unassigned49468
Lincoln4811
Big Stone4523
Grant4257
Norman4218
Mahnomen4077
Kittson36819
Red Lake3154
Traverse2443
Lake of the Woods1771
Cook1130

Iowa Coronavirus Cases

Data is updated nightly.

Cases: 302245

Reported Deaths: 4203
CountyCasesDeaths
Polk45206441
Linn17616270
Scott15300161
Black Hawk13616228
Woodbury12927175
Johnson1198649
Dubuque11275148
Pottawattamie8896112
Dallas879569
Story860433
Webster467269
Cerro Gordo461966
Sioux453151
Clinton447161
Warren436237
Marshall425161
Buena Vista391129
Muscatine384375
Des Moines379140
Plymouth348667
Wapello340097
Jasper317855
Lee312528
Marion300452
Jones269149
Henry262630
Carroll252833
Bremer241648
Crawford227822
Boone215316
Washington213831
Benton207943
Mahaska190636
Jackson190531
Tama185357
Dickinson183526
Delaware171836
Kossuth170141
Clay165519
Wright162324
Fayette159022
Buchanan157820
Hamilton157728
Harrison153862
Hardin153729
Winneshiek153019
Clayton150448
Cedar150019
Butler146123
Page143515
Floyd137436
Cherokee137325
Mills135516
Lyon133332
Poweshiek131424
Hancock128524
Allamakee126327
Iowa122522
Calhoun12189
Grundy119422
Jefferson119123
Winnebago118029
Madison11789
Mitchell115034
Louisa114129
Cass112141
Chickasaw110511
Sac110115
Emmet109931
Appanoose109038
Union108122
Humboldt104219
Guthrie102124
Shelby101126
Franklin100918
Unassigned9180
Palo Alto9009
Keokuk84225
Montgomery84022
Howard82119
Monroe80418
Clarke7757
Pocahontas77211
Ida73730
Greene6867
Davis68421
Adair68220
Lucas6458
Osceola6349
Monona62916
Worth5943
Taylor5909
Fremont5025
Van Buren49412
Decatur4784
Ringgold4269
Wayne41421
Audubon4118
Adams2933
Rochester/St. Mary'S
Cloudy
29° wxIcon
Hi: 31° Lo: 30°
Feels Like: 20°
Mason City
Cloudy
24° wxIcon
Hi: 27° Lo: 24°
Feels Like: 11°
Albert Lea
Cloudy
23° wxIcon
Hi: 26° Lo: 23°
Feels Like: 13°
Austin
Cloudy
27° wxIcon
Hi: 28° Lo: 26°
Feels Like: 16°
Charles City
Cloudy
27° wxIcon
Hi: 29° Lo: 27°
Feels Like: 15°
A quiet weekend ahead
KIMT Radar
KIMT Eye in the sky

Latest Video

Image

John Marshall ready for 2021

Image

Is the City of Rochester paying men and women equally?

Image

LWVMN asks for "truth and consequences" for state lawmakers

Image

Sports Overtime Part 2

Image

Sports Overtime Part 1

Image

Plans for polar plunge

Image

Equal work and equal pay.

Image

Aaron's Friday Night Forecast

Image

Mega Millions jackpot soars to $750 million

Image

Increase in 2021 travel plans

Community Events