11th-hour ruling on ACA creates turmoil

Insurance shoppers wanting to sign up for plans on the final day of Affordable Care Act enrollment awoke Saturday to confusion, fury and reports that the law had been declared unconstitutional.

U.S. District Judge Reed O’Connor in North Texas ruled Friday that because Congress removed the tax penalty that compelled nearly all Americans to carry health coverage last year, the entire law is invalid.

O’Connor sided with Texas Attorney General Ken Paxton, who led a coalition of state attorneys general who sued in February to challenge the viability of the ACA.

In his 55-page decision, O’Connor concluded that when Congress “sawed off the last leg” of the health care law by removing the tax penalty, it made the “individual mandate unconstitutional.”

The individual mandate is considered a pillar of the health care law, in that it required most everyone to carry health insurance to expand the risk pool.

Prior to the law, insurers could charge the chronically ill or those with pre-existing conditions much more for coverage or deny them outright as too risky.

O’Connor said that without the individual mandate, other provisions — including pre-existing condition protection — are “inservable and therefore invalid.”

The ruling, likely des-

tined for the U.S. Supreme Court, reverberated across news stations and social media, sowing dismay not only among procrastinating consumers but also those who already had bought plans.

“Is there even going to be insurance on the marketplace for 2019?” asked one customer calling into the phone bank of Houston insurer Community Health Choice.

“Is my plan that I’m enrolled in still effective?” asked another.

“If I enroll now, will this be good in 2019?” still another asked Angela Waltman, vice president of business development and call center operations for the regional insurance company that sells plans on the federal exchange.

“These are just a few people who called,” she said. “I worry about the tens of thousands of people who didn’t and might be confused or already made the decision not to enroll because they think there is no more insurance. And after today, it will be too late.”

Enrollment for individual and family plans on the federal exchange for 2019 closed at 11:59 p.m. Saturday.

Waltman and others at Community Health Choice said call volume this year was down about 20 percent from last year. Overall enrollment has lagged across the country.

As of Dec. 8, enrollment was reported down about 11 percent nationwide from last year and about 6 percent across Texas.

Joe Ibarra, co-chairman with the EnrollSA coalition in San Antonio, said he imagined enrollment was down in Bexar County as well.

“We anticipated a drop nationwide, statewide and locally before the enrollment season,” Ibarra said. “That’s just from what we’ve seen anecdotally.”

Ibarra said the drop could be due to several moves by the Trump administration: a cut in the advertising budget for enrollment, little funding for community groups that help with signups and elimination of the penalty for not having insurance.

In Bexar County, 26 plans were available to individuals and families from three insurers, almost identical to last year.

Insurers and health care advocates had counted on the traditional spike in signups that tends to come in the final days.

That’s why some saw the timing of the ruling as questionable, as the last day is usually the busiest.

“Cynical me would say it was timed intentionally,” said Katy Caldwell, executive director of Legacy Community Health, the largest network of health centers in Texas.

Already, Texas leads the nation in the number of uninsured. Millions of people nationally gained access to coverage through the health care law, either through individual plans bought on the exchanges or through Medicaid expansion. Texas is one of 14 states that didn’t expand Medicaid.

One person in particular was pleased with the ruling.

President Donald Trump tweeted: “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”

As the rhetoric flew, supporters of the law switched into damage-control mode, making clear the ACA still was the law of the land and that nothing had changed — at least not yet.

“Enrollment for health insurance plans will continue without interruption,” Austin-based Foundation Communities enrollment center said in a news release sent at 10 p.m. Friday. “If you need insurance come see us.”

Ken Janda, CEO of Community Health Choice, posted a message on Facebook at 5:45 a.m. Saturday: “Misguided and bad decision by Ft. Worth judge announced last night does not change anything for now. Sign up today!”

“I’m very confused. And concerned,” Houston teacher Dean Lowry said on Saturday after trying to make sense of the news.

“I have two of (the) preexisting conditions that they like to talk about,” he said of his ulcerative colitis and slow-progressing prostate cancer.

Although he’s insured, he worries about future premium increases that would make it unaffordable if the protection for those with pre-existing conditions vanishes.