Seven months after a federal judge struck down the Affordable Care Act, a coalition of 21 Democratic attorneys general will once again defend the landmark healthcare law in New Orleans on Tuesday. The challenge, if upheld, would have far-reaching consequences for millions of Americans and the healthcare companies that serve them.
Left-leaning and conservative legal experts alike say there's little chance the three-judge panel in New Orleans agrees with the lower court and declare the ACA unconstitutional. The arguments used by the Republican states that sued to wipe out the ACA are "frivolous," the experts say.
"This case is different from all of the previous Obamacare cases because there is a consensus among the Republican intellectual establishment that the legal arguments are frivolous," said Yale University health law professor Abbe Gluck. "You've got a lot of prominent Republican legal experts siding against the Trump administration in this case, so I think that most people are hoping that this circuit will apply very settled law and reverse the lower-court decision."
Even so, Democratic senators on Monday were worried that the ACA would ultimately be struck down, causing millions of Americans to lose their insurance and consumer protections overnight without any Trump administration plan to pick up the pieces.
"Make no mistake, this lawsuit has a good chance of succeeding," Sen. Chris Murphy (D-Conn.) said during a conference call Monday with reporters. "I understand that there are some legal scholars that say that the theory of the petitioners is wacky, but it survived the district court and it now has the administration as a full and complete partner with the attorneys general. There is real muscle on the side of the plaintiffs in this case."
The appellate court arguments largely mirror those in the district court. This time around, the U.S. Justice Department is urging the 5th U.S. Circuit Court of Appeals to uphold the lower-court ruling that the entire Affordable Care Act must fall because the 2017 Congress reduced the individual mandate penalty to zero. Previously, the Justice Department argued the individual mandate is unconstitutional, but could be "severed" from most of the ACA.
This question of whether the entire ACA must go is the crux of the case. Gluck explained that a non-controversial, settled legal doctrine called "severability" states that the decision to scrap a piece of a law or destroy the whole thing rests on what Congress would have wanted. That's something courts usually have to guess, but in this case there's no question what Congress would have wanted: it already zeroed-out the individual mandate penalty and left the rest of the ACA alone.
"It is an absolutely outrageous argument to say that the district court was doing what Congress wanted when Congress in 2017 reduced the penalty and left the entire statute standing," Gluck said.
Nicholas Bagley, a law professor at the University of Michigan Law School, similarly said, "These are bad legal arguments."
The odds of the Fifth Circuit declaring the entire ACA unconstitutional are low, he said, given the arguments in the case "are thin to the point of frivolousness, and I think the Fifth Circuit judges will know that, whatever their political disposition may happen to be. But I'd be lying if I said I knew that for sure."
The panel announced last week includes Judges Jennifer Walker Elrod, Kurt Englehardt and Carolyn Dineen King. Two were appointed by Republican presidents; one is a Democratic appointee. U.S. District Judge Reed O'Connor, who struck down the healthcare law, was also appointed by a Republican president.
Legal experts said it is also likely that oral arguments will devote time to whether the Democratic states and the U.S. House of Representatives have standing to intervene in the case. The Fifth Circuit judges last week asked for supplemental briefs on that question. While the court's request was seen by some as a sign that it is supportive of the Republican states, others viewed it as normal, given the high stakes and the fact that the Justice Department declined to defend the law.
Gluck said it's unlikely the court will decide neither the blue states or the House have standing in the case. It would be hard to argue that the Democrat-led states would not be harmed by a ruling that invalidates the entire ACA, and the House has previously intervened to defend a statute when the executive branch chose not to, she said.
But if the Fifth Circuit does decide neither have standing, it would have to decide whether to let the lower-court decision stand or erase it, she said.
Should the appellate court uphold the lower-court ruling, the consequences would be sweeping. In a June analysis, the left-leaning Urban Institute found that the number of uninsured Americans would climb 65% to 50.3 million in 2020 if the ACA is ultimately struck down. The decision would affect not only people who buy coverage in the individual market but also those with coverage through Medicaid expansion, Medicare and from their employers.
That would also impact healthcare providers and insurers.
"No industry has been more directly impacted by the ACA than health insurance providers, which have invested vast amounts of resources to participate in the relevant markets, comply with the law's myriad reforms, and organize their businesses to operate in a revamped healthcare system," insurance industry lobbying group America's Health Insurance Plans wrote in an amicus brief filed in April in support of reversing the lower-court decision.
