Responding to the latest effort to weaken or repeal the Affordable Care Act (ACA), California Attorney General Xavier Becerra announced he is appealing a district judge's December ruling that the landmark health care law is unconstitutional.
In a statement last week, Becerra announced he and 16 other state attorneys general were appealing U.S. District Judge Reed O'Connor's decision in the case Texas v. United States, which concluded that the individual mandate -- the requirement that citizens must purchase health insurance or pay a fine -- was unconstitutional. O'Connor went on to rule that the remaining provisions in the ACA were "inseverable" from the individual mandate and "therefore invalid" as a result of the decision, dismantling the entire framework of the health care law, also known as Obamacare.
Becerra immediately responded to the Dec. 14 by calling it "misguided" and an "assault" on 133 million Americans who rely on the ACA for its protections of patients with preexisting conditions. The ruling is now moving up to the Fifth Circuit Court of Appeals, and could eventually be reviewed by the U.S. Supreme Court.
Though Santa Clara County is not a party in the case and the appeal, county officials have kept a close watch on the case because of the deep impacts it would have on both the county's finances and health and hospital system as well as the health of the community, according to County Counsel James Williams.
Since March 2010 when the law was enacted, Williams said the ACA has been "incredibly positive" for the community, insuring more county residents and reducing the costs and burdens on the county's hospital system. He said that Santa Clara County has been "at the forefront" by showing how effective the Affordable Care Act can be.
"I think California has been able to show a lot of what was intended to happen everywhere in the country by having robust enrollment and robust outreach -- a state that was actually taking advantage of the flexibility and the structure under the ACA," Williams said. "And the results speak for themselves."
This is hardly the first time the ACA faced possible repeal. Last year the Republican-controlled House of Representatives and Senate sought to repeal part or all of the ACA through multiple bills that ultimately failed to muster enough votes. Burt Margolin, a consultant hired by the county to watch federal legislation, reported to supervisors last month that certain efforts to weaken the health care law -- reducing the individual mandate penalty and internal changes by the Centers for Medicare and Medicaid -- appear to have dropped enrollment by about 13 percent from last year.
Margolin said that, if the Texas case makes it to the Supreme Court, the ruling may be favorable. Earlier in December the majority of the court, including Justice Brett Kavanaugh and Chief Justice John Roberts, declined to review lower court decisions that found Kansas and Louisiana had violated federal law by defunding Planned Parenthood for apparently arbitrary reasons not related to performance.
"The speculation is that Roberts may have wanted to avoid pushing this fight into a contentious battle over health care at the Supreme Court level, and that may bode well should the Texas (court) case reach his court," Margolin said.
Last year, Margolin said an estimated 130,000 residents in Santa Clara County gained Medi-Cal coverage through the Medicaid expansion under the ACA, 68,000 of whom are served directly through the county's health and hospital system and Santa Clara Valley Medical Center.
Williams said the ruling by O'Connor "defies common sense" by claiming the law was effectively repealed last year when Congress reduced the individual mandate penalty down to zero, and that there are staggering ramifications to a ruling that claims every single word is struck from the ACA as a result. That includes components that won huge support, including allowing children to stay on their parents' insurance plans until age 26 and protections for people with preexisting conditions.
"It would upend the private health care system for everyone," he said. "And yet somehow the district court judge is saying 'Well, actually (Congress) meant to strike everything down."
It was clear last year that Congress didn't have the votes required to repeal the ACA in its entirety, and that a succession of bills and votes proved that, Williams said. O'Connor's narrow analysis is divorced from what took place in the Legislature and "fails to actually grapple with the body of the law as a whole," he said.
Williams said he couldn't say for sure how the ruling would fare in the Fifth Circuit or the Supreme Court, but he emphasized that the ramifications of the case are huge.
"This is the largest sector of the economy -- this is not a minor set of statutes that we're talking about," he said. "The ramifications for striking the entire Affordable Care Act would upend all aspects of the health care system, every single person, regardless of who your insurer is."