Major Medical, Patient Groups File to Defend ACA in Texas Case Against HHS

Allison Inserro

This story has been updated to reflect a second brief filed by patient organizations and a third brief by legal experts.

Major medical groups and patient advocacy organizations filed friend-of-the-court briefs Thursday in Texas v. Azar, the lawsuit that seeks to overturn the Affordable Care Act (ACA), and warned of dangers to healthcare and to patients with chronic disease if access to healthcare becomes unaffordable.

In addition, legal experts in constitutional law, statutory interpretation, legislation and administrative law—who have previously disagreed with each other on other legal and policy questions about the ACA—united in another filing, saying the arguments of both "the plaintiff States and the United States on the severability of the insurance mandate from the other provisions of the ACA are inconsistent with settled law."

The American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry filed as amici curiae in opposition to a Texas-led lawsuit seeking to declare the ACA unconstitutional, based on the idea that when President Trump’s tax reform act last year ended the individual mandate, the entire law became unconstitutional.

Not so, says the brief, writing that the “requested remedies will wreak havoc on American health care.”

The legal argument advanced has no merit because the states do not have standing under Article III of the Consititution, and, if allowed, would erode the separation of powers between Congress and the executive branch of the federal government.

The ACA has flaws, the organizations said, but changing it is for Congress, not the courts, to decide.

“Congress declined to do what the Plaintiffs ask this Court to do for a reason: the consequences of repealing the ACA would be staggering,” the brief states.

The lawsuit, filed in February by Texas and other GOP-led states, is essentially a replay of the politically divided litigation that ended with the Supreme Court upholding the healthcare overhaul in 2012.

Last week, Department of Justice, instead of defending the federal law, refused and said, “that, in Texas v. United States, No. 4: l 8-cv-00167-O (N.D. Tex.), the Department will not defend the constitutionality of 26 U.S.C. 5000A(a), and will argue that certain provisions of the Affordable Care Act (ACA) are inseverable from that provision.”

California is leading a group of Democrat-led states in defending the law.

"Invalidating the guaranteed-issue and community rating provisions—or the entire ACA—would have a devastating impact on doctors, patients, and the American health care system as a whole," the medical groups wrote.

Millions of Americans could lose their healthcare coverage or face higher premiums for having preexisting conditions if the Texas suit is successful. 

In the second brief, the American Cancer Society, American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, and National Multiple Sclerosis Society said the ACA has made considerable progress in reducing problems for patients with cancer, diabetes, lung disease, heart disease, stroke and multiple sclerosis who want and need health insurance, but without the ACA, could not access it or afford it.

It also says it was the intent of Congress, when it passed the ACA, to provide a way for people to obtain health insurance, without which they would suffer worse outcomes. 

"The question is thus not whether individual Americans will incur health care expenses, but how those expenses will be financed," the brief said. 

In the third brief filed Thursday, law professors Jonathan H. Adler, Nicholas Bagley, Abbe R. Gluck, Ilya Somin, and Kevin C. Walsh said that the court must take into account the damage to the law in question and "be guided by Congressional intent" when deciding the issue of severability.

This week, some Republicans said they never meant for Americans to lose certain consumer protections in healthcare. "There’s no way Congress is going to repeal protections for people with preexisting conditions who want to buy health insurance. The Justice Department argument in the Texas case is as far-fetched as any I’ve ever heard. Congress specifically repealed the individual mandate penalty, but I didn’t hear a single senator say that they also thought they were repealing protections for people with preexisting conditions," said Senator Lamar Alexander, R-Tennessee, chairman of the Senate’s health committee.

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