Protesters supporting the Affordable Care Act in Fort Worth earlier this year.
Protesters supporting the Affordable Care Act in Fort Worth earlier this year.
Stephen Young

What Friday's Affordable Care Act Ruling Means for Texas

The headline — "Fort Worth Judge Strikes Down Affordable Care Act" — was easy enough to understand, at least on its face, Friday evening. The potential fallout was harder to break down. Yes, U.S. District Judge Reed O'Connor, handpicked by the Texas Attorney General's Office to hear its claims that the healthcare law was unconstitutional, had agreed with the plaintiffs. Obamacare wasn't done, though, not by a long shot.

In the moments after O'Connor's decision became public, even Texas Attorney General Ken Paxton, the public face of the lawsuit, got things wrong. In a press release, he praised O'Connor for "granting a nationwide preliminary injunction" against the Affordable Care Act.

Fourteen minutes later, he issued a new press release and statement removing any mention of an injunction.

“Today’s ruling halts an unconstitutional exertion of federal power over the American healthcare system,” Paxton said. “Our lawsuit seeks to effectively repeal Obamacare, which will give President Trump and Congress the opportunity to replace the failed social experiment with a plan that ensures Texans and all Americans will again have greater choice about what health coverage they need and who will be their doctor.”

The White House, like Paxton, was quick to praise the ruling but emphasized that Obamacare will remain in effect through what is sure to be a lengthy appeals process.

“Obamacare has been struck down by a highly respected judge. The judge’s decision vindicates President Trump’s position that Obamacare is unconstitutional. Once again, the president calls on Congress to replace Obamacare and act to protect people with pre-existing conditions and provide Americans with quality affordable health care," White House press secretary Sarah Sanders said in a statement. "We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place.”

O'Connor's decision not to issue an injunction and a commitment by Seema Verma, administrator for the Centers for Medicare & Medicaid Services, to keep health insurance exchanges open mean that nothing is changing now for Texans who rely on the ACA for health coverage, says Stacey Pogue, a senior policy analyst at the Center for Public Policy Priorities in Austin.

"This is a pretty reckless ruling that could have terrible implications for those who need access to health care," Pogue says, "but it's important to know that the ACA is still the law of the land. I think there is a lot of concern and confusion among consumers who've already picked their plans for next year — who depend on pre-existing condition protections, who depend on no-cost preventive care — who say, 'Oh my gosh, what's going to happen?' Nothing happens right away."

As Paxton's lawsuit against the ACA winds through the courts, Pogue says Texas must work to ensure coverage for those getting their insurance through Obamacare should the law come off the books.

Texas Gov. Greg Abbott said Monday that he's committed to covering those with pre-existing conditions, something his attorney general is explicitly fighting against in the lawsuit.

"If Obamacare remains struck down on appeal Texas will be ready with replacement health care insurance that includes coverage for preexisting conditions," Abbott said via Twitter. "We will also work with Congress to ensure Texans have access to the healthcare insurance they need."

While CPPP supports Abbott's goal, Pogue says, the devil is going to be in the details.

"Texas has the worst uninsured rate in the nation. That's true today, it was true before the ACA," she says, "but we've never had the leadership from the executive office or other statewide leaders — not just the governor — to really take that head-on and fix our worst-in-the-nation uninsured rate. It would take a whole lot of leadership, planning and commitment to do that. Texas can. Other states have, but there's not been any work to date to demonstrate that we can move in that direction." 

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