What Does the Texas Ruling Against the ACA Mean for the Cancer Community?

What Does the Texas Ruling Against the ACA Mean for the Cancer Community?

In a potential threat to the cancer community, on Friday night, just hours before the end of Marketplace open enrollment, a Texas judge ruled that the Affordable Care Act is unconstitutional. What does this mean for the cancer community? In order to understand the ramifications of this decision, it’s helpful to start at the beginning.

If you have been to our educational events or read our blogs, you have probably heard about the many consumer protections included in the ACA that have benefited the cancer community. Those protections are in danger of disappearing, in the flick of a pen.

Here’s what’s happened so far…

  • In December 2017, Congress passed the “Tax Cuts and Jobs Act” that reduced the tax penalty, which people have to pay if they don’t have health insurance (aka “the individual mandate”) to $0, starting in 2019.


  • On February 26, 2018, Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimmel, lead a group of 16 other Republican state attorneys general (AL, AR, AZ, FL, GA, IN, KS, LA, MO, NE, ND, SC, SD, TN, UT, WV), two governors (ME and MS), and two individual plaintiffs in challenging the constitutionality of the Affordable Care Act. Their argument is that the individual mandate will no longer be a way for the federal government to raise tax revenue. This argument is based on the decision in a 2012 U.S. Supreme Court case (National Federation of Independent Businesses v. Sebelius), which upheld the constitutionality of the ACA, and the individual mandate in particular, in a 5-4 decision, ruling that the “penalty” was in fact a “tax.”


  • On June 7, 2018, the U.S. Department of Justice announced that it would not defend the federal law in court. This is a significant break from the executive branch’s tradition of arguing to uphold existing federal statutes when challenged in court.


  • On June 8, 2018, California Attorney General Javier Becerra, along with 16 Democratic state attorneys general announced they would step into the case to defend the ACA (CT, DC, DE, HI, IL, KY, MA, MN, NJ, NY, NC, OR, RI, VT, VA, WA).


  • On September 5, 2018, Texas judge, Reed O’Connor, of the federal district court in the Northern District of Texas heard oral arguments for this case. Here’s what each group in the case wants to happen with the ACA:


U.S. Department of JusticeRepublican Attorneys General: AL, AR, AZ, FL, GA, IN, KS, LA, MO, NE, ND, SC, SD, TX, TN, UT, WI, WV; Governors: ME and MSDemocratic Attorneys General: CA, CT, DC, DE, HI, IL, KY, MA, MN, NJ, NY, NC, OR, RI, VT, VA, WA
What each groups wants to happen to the ACAThe individual mandate and these consumer protections to go away:

guaranteed issue (i.e., prohibiting insurance companies from denying people with a pre-existing condition to buy or renew health insurance)

community rating (i.e., prohibiting insurance companies from charging women, older adults, and people with pre-existing conditions, or past medical conditions more for health insurance)

ACA and ALL of its protections for consumers to go away.ACA and ALL of its protections for consumers would stay in place.


  • On December 14, 2018, the judge released his ruling, agreeing with the Republican 20-state coalition that the entire ACA is now unconstitutional.

Here’s what might happen from here….

  • The Democratic State Attorneys General are expected to appeal any moment to the Fifth Circuit Court of Appeals.


  • Regardless of the outcome at the Firth Circuit, it’s likely to be appealed to the U.S. Supreme Court.

What does this all mean for right now?

  • People who picked plans in the Marketplaces for 2019, will have their insurance for the year. And, all of the other protections in the ACA will continue while this case goes through the courts.


  • If the ACA is ultimately ruled to be unconstitutional by the Supreme Court it would mean a minimum of 20 million Americans would lose their health insurance coverage and those with employer-sponsored health insurance could face pre-existing conditional exclusions once again.

Do You Need Health Insurance Now?


    • For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our short animated video or this longer recorded webinar.


  • If you aren’t sure what your health insurance options are or want to understand more about health insurance, visit CancerFinances.org.

What You Can Do to Protect Cancer Survivors

  • Contact your elected officials at the state and federal level. Even if you know your elected official’s position on the Affordable Care Act, it is useful to share your thoughts as one of their constituents. States are also taking actions to pass state-level protections for people with pre-existing conditions.


  • To find your elected officials or learn more about becoming an advocate, visit our Advocacy resource page. You can also find the Facebook and Twitter handles for the current members of Congress here.

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available, about this issue that affects all of us.

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Monica Bryant