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Affordable Care Act Challenge is High Steaks for Texas following Ginsburg's Death

After Ginsburg’s death, high stakes for Texas’ legal challenge to the Affordable Care Act

Experts say the Supreme Court is unlikely to strike down the law in its entirety. Texas’ GOP leaders have yet to produce a promised plan to replace it.


As a Texas-led lawsuit to end the Affordable Care Act made its way through the federal courts in 2018, Gov. Greg Abbott pledged that should his state’s legal team succeed, he and his policymakers would have a plan ready to keep Texans — including the millions with preexisting health conditions — insured.

Now that the unlikely lawsuit has perhaps its best odds yet, with a hearing set for Nov. 10 before a U.S. Supreme Court that no longer includes liberal Justice Ruth Bader Ginsburg, Texas Republicans have yet to show any evidence that such a plan exists.

Texas Attorney General Ken Paxton, a Republican, set out in 2018 to achieve through the courts what his party tried and failed for years to achieve in legislation: the end of President Barack Obama’s landmark health law. Paxton, leading a team of red states, argued that after Congress effectively neutered a key provision of the law — the individual mandate — that provision was unconstitutional and the rest of the law had to fall as well.

The lawsuit won early success in a federal court in Texas and then at the U.S. 5th Circuit Court of Appeals, and now it’s before a Supreme Court that appears likely to tilt more conservative if the U.S. Senate quickly confirms President Donald Trump’s third nominee to the high court.

Experts who have long dismissed the lawsuit as a long shot say the Affordable Care Act faces new uncertainty, though they are betting on its survival.

A legal victory for the state in this case would herald an immediate policy emergency for Texas lawmakers. The state has long boasted the nation’s highest uninsured rate, a gulf that has only widened this year as millions of Americans lost employer health coverage during the coronavirus pandemic. And because the Affordable Care Act touches so many facets of health care policy, from insurance benefits to the federal process for approving certain prescription drugs, the effects of its repeal would be felt by virtually everyone.

If the Supreme Court struck down the law, some 1 million Texans would lose subsidized health insurance plans. It would also end popular consumer protections for patients with preexisting health conditions and for young adults who are allowed to stay on their parents’ health plans until age 26.


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