A federal judge of the Fort Worth, Texas U.S. District Court challenged the constitutionality of the Patient Protection and Affordable Care Act (ACA). During mid-December, Judge Reed O'Connor presided over the Republican-led Texas vs. US lawsuit that challenged the ACA. The President George W. Bush appointed judge, in his Friday ruling, said the mandate requiring people to have health insurance "can no longer be sustained as an exercise of Congress tax power."

Why Did Texas Judge O’Connor Call ACA Unconstitutional?

In 2012, the Supreme Court deemed ACA’s mandate as constitutional. It based its decision largely on Congress's power to tax. Specifically, Article I, Section 8 of the Constitution enumerates 17 powers of Congress. Among these powers it exercises the power "to lay and collect taxes." ACA, by taxing those who fail to buy health insurance, based upon the Supreme Court decision, supported Congressional authority with regard to the act.

However, the 2017 federal reform, backed by President Donald Trump, made ACA changes regarding taxation of individuals who failed to buy health insurance. As a consequence, O’Connor ruled that ACA changes, which excluded the penalty tax, made the act unconstitutional. The legislative process views Acts in their entirety rather than a collection of distinct mandates. Consequently, the unconstitutionality of the specific taxation mandate deems the entire act unconstitutional.

Will the Texas Judge Ruling Result in ACA Changes?

O’Connor’s ruling could signal ACA changes or even complete overturn. However, from the judge’s Texas District chambers, an appeal would move it to the Court of Appeals for the Fifth Circuit, which resides over Texas, Louisiana, and Mississippi. If the Fifth Circuit’s court supports O’Connor’s decision, it would move into the Supreme Court.

For now, the ACA remains in effect, presenting no immediate threats to the 8.8 million people who signed up by the December deadline. According to the National Council’s Capitol Connector, “Legal experts are overwhelmingly skeptical that Judge O’Connor’s ruling will be upheld through the appeals process.”

Will the Texas Judge Ruling Result in 2019 ACA Changes?

According to CNBC, “The United States could match or exceed the 12.2 million people who signed up throughout the country in the last sign-up period.” How might the ruling affect millions of Americans, including those eligible for coverage despite pre-existing conditions?

The Trump administration, legally, could pull any component of ACA out of service as of the beginning of the 2019 year. Even so, the potential political, legal, and budget turmoil of such actions make significant ACA changes unlikely in the upcoming year.

The judicial process required to overturn the act, moving it from the Texas District upward to the Fifth Circuit and eventually to the Supreme Court, would, if successful, require several years. Most likely, the upcoming 2019 coverage period should experience no significant impact from the decision.

How Could the Texas Federal District Court Decision Affect ACA’s Future?

What could happen in a few years depends upon the outcome of next year’s appellate decision. ABC News warns that overturning ACA could impact more than 20 million Americans who were uninsured prior to the Act. It described potential hindrance of the healthcare system, alteration of Medicare and Medicaid, and risks to other health programs and even Trump’s health agenda. For now it’s difficult to predict how ACA might look in a decade.