Can State Laws Challenge Health Reforms?

State laws can challenge health reforms. The results of these challenges vary greatly.  

A recent example of this is from December of 2018 when some members of 48 or more state legislatures, proposed legislation to limit, alter or oppose selected state or federal actions in response to federal health reform law.


When the Patient Protection and Affordable Care Act (PPACA) commonly referred to as the Affordable Care Act (ACA) or Obama Care, was in affect from 2010 to 2018, many states demanded change in this federal health care reform that drastically overhauled the Medicare and Medicaid programs, as well as made significant changes to individual health insurance markets. Even though the number of uninsured Americans was cut in half when the ACA went into full affect, many states fought to change these groundbreaking reforms, arguing that things such as the individual mandate penalty are unfair.

From 2017 until now, much of the focus for health policy has shifted to multiple alternatives as laid out in the American Health Care Act (AHCA) and related congressional measures. As of yet, none of these discussions, proposals and congressional action have become laws.

State Challenges to the ACA

On Dec., 17, 2018 a federal District Court judge in Texas ruled that the individual mandate that imposed a tax penalty on uninsured individuals and families was unconstitutional. The judge issued an opinion that the entire ACA is invalid because Congress reduced to $0, the tax penalty tied to its individual mandate. This case was initiated at the beginning of 2018 by 20 state attorneys general seeking to end Obama Care (the ACA). It was soon defended by 16 other states and Washington D.C.

This ruling is considered to be a victory for Republican state attorneys general that challenged the ACA. The plaintiffs’ (the Republicans) case centered on what they said was, “the inseverability of the ACA’s individual mandate – which the Supreme Court upheld in 2012 as a tax – from the rest of the law.” Their claim is that when the tax penalty for noncompliance drops to $0 in January 2019, the mandate must be unconstitutional and thus, the entire ACA is invalid as well.

While Congress continues to discuss, propose and take action on the AHCA, the ACA continues to be active law, pending the appeals process. It is anticipated that this will reach the Supreme Court.

Looking Ahead on State Laws Challenging Health Care Reforms

Even though a federal district court ruled that the Affordable Care Act is unconstitutional, the act itself and litigation to uphold its validity and necessity in American society will continue. There has been no nationwide injunction which would have rendered the ACA as invlaid and would have ceased all aspects of the law. The states defending the law say that they will appeal this ruling.

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