The Battle Over the ACA

The Supreme Court is set to decide the future of The Affordable Care Act

Florida Medical Providers Await The High Court’s Ruling

By Patrick Sullivan, Esq.Sinead Killeen, Esq., and Stephanie Michelle Viel, Esq.

The Supreme Court of the United States heard oral arguments today in the consolidated cases titled California et al. v. Texas et al. and Texas et al. v. California et al., which could determine the fate of the Affordable Care Act (“ACA”), its protections, and the health insurance coverage of 20+ million Americans. Tens of millions of Americans gained insurance coverage under the ACA, which includes popular provisions such as guaranteeing coverage for individuals with pre-existing conditions and forbidding insurers from denying them coverage or charging them more. In the past ten years, thousands of Florida doctors and medical groups expanded their networks and accepted patients with coverage under the Affordable Care Act. Many states, including Florida, have laws that protect and assist individuals and medical professionals in lawsuits against health insurers. The Court’s decision could have a major impact on the financial stability of these medical practices and the preventative care that patients receive. With the stakes so high for many providers, Lubell Rosen is watching these cases closely.

The challenge to the ACA, which became the law a decade ago, is led by Texas Solicitor General, Kyle Hawkins, and acting Justice Department Solicitor General Jeffrey Wall, who represent a coalition of 18 conservative-leaning states. The ACA is being defended by Michael J. Mongan, the Solicitor General of California, representing a coalition of liberal-leaning states.

Past Challenges

This is third time in eight years that the Supreme Court has determined the fate of the ACA. In National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012), the Supreme Court upheld the ACA and the individual mandate in a 5 to 4 vote. The main issue before the Supreme Court was whether the individual mandate—the provision of the ACA requiring that most individuals and their families have health insurance or face a penalty—was constitutional. The Court’s majority opinion written by Chief Justice Roberts upheld the individual mandate as a constitutional exercise of the Congressional power to implement taxes.

In 2015, the Supreme Court again heard a challenge to the ACA in the case King v. Burwell, 576 U.S. 473 (2015). In this case, the plaintiffs challenged the tax credit provision of the ACA, which authorized tax credits for purchases of state-established and federal government established healthcare exchanges. The Supreme Court upheld the ACA and the tax credit provisions in a 6 to 3 decision.

The Tax Cuts and Jobs Act and the Current Challenge to the ACA

In 2017, Congress passed the Tax Cuts and Jobs Act (“TCJA”), which set the tax penalty for failing to purchase health insurance to $0, effectively eliminating the individual mandate. Following the TCJA, Texas and other republican states sued the federal government in 2018 arguing that the reduction of the mandate renders the entire ACA unconstitutional – an argument that ignores Congress’ choice to leave the ACA intact when it zeroed out the tax penalty. The new challenge starts with the argument that this made the individual mandate unconstitutional because it could no longer be considered a tax.

California and other democratic states first argue that the plaintiffs do not have standing to challenge the ACA’s individual mandate because they did not suffer any injury from paying a $0 penalty. More substantively, California goes on to argue that the individual mandate was not repealed by Congress but was instead reduced to $0. The main argument is that even if the individual mandate is found to be unconstitutional that provision should be severed from the legislation, as the rest of the ACA is constitutional and should be allowed to remain in place.

The issue of severability may be the most important issue being brought before the Court. If the Supreme Court decides that the individual mandate is unconstitutional, the question becomes whether the entire Act is unconstitutional or whether the individual mandate portion can simply be severed from the Act.

Notably, a lot has changed since the Supreme Court last heard a challenge to the ACA. Justices Gorsuch, Kavanaugh, and Barrett have joined the Court. Barrett previously criticized Chief Justice Roberts for his opinion in NFIB v. Sebelius, saying that he “pushed the Affordable Care Act beyond its plausible meaning to save the statute.” With a conservative majority now in the highest Court the ACA, and the protections it affords to millions of Americans, faces its greatest challenge to date.

During oral arguments several of the Court’s conservatives Justices expressed an unwillingness to strike down the ACA entirely. Chief Justice Roberts and Justice Kavanaugh suggested that the Court may cast aside the individual mandate while leaving the rest standing. “It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the law in place,” said Justice Kavanaugh.

Effects of Striking Down ACA 

The practical effects of striking the ACA would cause significant uncertainty in America’s health system. If the Supreme Court strikes down the ACA in its entirety, more than 20 million Americans will be without health insurance in the middle of a pandemic. Striking down the ACA would also eliminate the Medicaid expansion, causing millions of low-income individuals to become uninsured. Young adults would no longer be able to stay on their parents’ plans up to age 26, and insurers would once again be allowed to sell policies with annual and lifetime limits on coverage, including for people with employer plans.

Lubell Rosen’s recovery efforts against ACA carriers:

The law firm of Lubell Rosen represents individuals, doctors, and medical groups in cases against health insurance companies for the underpayment and denial of insurance claims. Many states, including Florida, have laws that protect and assist individuals and medical professionals in lawsuits against health insurers. Lubell Rosen leads the efforts in assisting medical providers in their endeavors to recover unpaid ACA medical benefits from insurers. ACA cases are generally handled on a contingency fee basis, meaning that the law firm only gets paid if the provider gets paid.

The lawyers at Lubell Rosen are familiar with the issues doctors face on a daily basis with the underpayment and denial of insurance claims. This is especially prevalent when a doctor sees patients who are out-of-network. In Florida, the law requires that an insurance company pay out-of-network medical providers the “usual, customary, and reasonable” amount for the services provided. However, insurance companies rarely pay out-of-network medical providers the proper amount. Lubell Rosen is actively engaged in litigation with all ACA payers in Florida due to blatant underpayments.

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