After Obamacare Ruling, States Ask Judge to Protect Coverage During Appeal Process

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The ruling, which was issued Friday by Judge Reed O'Connor of the Federal District Court in Fort Worth, holds that the federal mandate requiring the purchase of health insurance is unconstitutional, and that as a effect, the whole of the Affordable Care Act (ACA) is legally invalid. Hospital chains HCA Inc. and Tenet Healthcare Corp. dropped... CNBC reported that Centene shares went down 7.5%; HCA Healthcare, which is the largest for-profit operator of health care facilities in the USA, dipped 5%, and insurance companies Cigna and Humana saw their shares decrease by 4%.

Millions of individuals and families covered through the ACA's Medicaid expansions would lose coverage - even in states that have recently passed referenda to expand coverage - but other Medicaid beneficiaries would lose benefits conferred by the ACA as well.

Judge O'Connor points to the "findings" from the original ACA itself to claim that the mandate was "essential" to various provisions of the law, but those findings were included to bolster arguments that the mandate was constitutional as a legal requirement and were not meant to make the rest of the law dependent on the mandate.

With uncertainly roiling sector shares, some sensed an opportunity and stepped in.

Most people, including those in the White House, expect the appeals process will land the case before the Supreme Court. Republicans, including President Donald Trump, have long criticized the law, calling it a costly and unneeded government intrusion into Americans' lives. The Republican-led Congress a year ago eliminated a penalty that the ACA levied on people who opted not to obtain insurance.

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That, in part, helps explain why so many Republican candidates claimed to support those protections while campaigning in the 2018 midterms, despite the fact that a group of Republican state attorneys general filed the lawsuit that resulted in Friday's ruling, which threatens to wipe away the ACA's protections if upheld. The court did not issue an injunction, and the Trump administration has asserted that it will continue to enforce the terms of the ACA pending appeal, notwithstanding its vocal opposition to the law. The Trump administration declined to defend the mandate, spurring Democratic officials in 16 states to intervene.

Most legal experts, including conservatives who oppose the mandate, believe the portion of O'Connor's ruling striking down the entire law will be reversed. The law still works without it. Congress in its wisdom has declared that it's severable, has said, look, we're going to keep the law but remove the mandate penalty. The selloff is occurring although the judge's decision will be appealed and won't affect Americans who signed up for 2019 health coverage.

The 2012 Supreme Court case was over whether such a penalty was legal - but now that it is gone, O'Connor says the whole Affordable Care Act should be stricken down because the provision is "the keystone" of the program. As a Wall Street Journal editorial noted Monday, Roberts saved the law in 2012 by describing the mandate penalty as a tax - something Congress has unquestioned authority to impose. But the judge also held that because the ACA is not financially viable without the mandate, the entire law had to be struck down.

The President tweeted on Friday: "Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions".

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