The eyes of the health care world will be on a New Orleans courtroom Tuesday, as a panel from the Fifth Circuit Court of Appeals considers whether the Affordable Care Act should live or die.
On one side are 18 states, led by Texas, seeking to invalidate the law often referred to as Obamacare. On the other are 20 states and the District of Columbia, which are asking the court to uphold it.
And while Louisiana is among the plaintiffs, its residents should be hoping the state’s side loses.
The law itself has always been divisive. It was adopted by Congress on a party-line Democratic vote in 2010, signed by a Democratic president and bashed by Republican politicians ever since — including Louisiana Attorney General Jeff Landry, who signed on to the suit without consulting Democratic Gov. John Bel Edwards, who opposes it. A map of states on each side paints a picture of red and blue America. The Trump administration is taking the highly unusual position of backing the plaintiffs rather than defending existing law.
But far more important than the politics is the fact that the law has been reality for nearly a decade, and that Louisianans rely upon its protections. These include a list of essential benefits that must be covered by each plan, such as pregnancy, hospitalization, and substance abuse; the right for young adults to stay on their parents’ plans; lifetime limits on out-of-pocket expenses; and rights for people with preexisting conditions. The law also expanded Medicaid, a provision that the framers intended to be universal but the U.S. Supreme Court later allowed states to adopt or reject.
It had unpopular provisions too, including a mandate that most people carry insurance or face a financial penalty. After they failed to repeal and replace the law, congressional Republicans zeroed out the penalty as part of its party-line tax overhaul. A Texas federal judge used this change to declare the whole law invalid, a decision that has drawn criticism from legal experts and is now under appeal.
The fight over the national law is the backdrop for a recent battle over a new state law that Landry championed. It seeks to recreate some of Affordable Care Act’s protections, but does not include a way to pay for preexisting condition coverage without an influx of federal money. Nor does it address Medicaid expansion, a signature initiative by Edwards that now covers more than 450,000 Louisianans. Edwards signed the law reluctantly and was right to do so, given that it would be a start in recreating what would be lost if the ACA were to disappear. But despite Landry’s claims, it falls far short of providing stability should his suit succeed.
The status quo has its shortcomings, including high costs for some customers in the individual market, but they can and should be addressed by Congress. The suit’s aim, to have judges to throw the whole thing out instead, would create unnecessary, widespread disruption. It wouldn’t serve anyone’s interests other than politicians seeking bragging rights.