Adapted from a summary by the National Health Law Program

Last Friday, Judge Reed O’Connor of the Northern District of Texas ruled that the individual mandate of the Affordable Care Act was unconstitutional. He went even further, striking down the entire ACA because, he opined, the mandate was not “severable” from the rest of the law. This suit was filed by a group of 20 states, led by Texas. Although the U.S. is the defendant in this case, the Administration chose not to fully support the law. As a result, Washington and 15 other states led by California intervened in the case, along with the District of Columbia.

The plaintiffs filed the case in a court where Judge O’Connor is the only judge. They chose this forum because of O’Connor’s record and reputation – he was the judge who struck down regulatory protections for transgender students and held that the Indian Child Welfare Act was unconstitutional.  

Among other things, Judge O’Connor held that when Congress removed the penalty for people who don’t have insurance in 2017, the mandate could no longer function as a tax. He then went further to rule on the question of whether or not Congress would have wanted the rest of the statute to remain in effect without the mandate. While this is considered a question of congressional intent and judicial interpretation, the doctrine cautions that judges should preserve a law whenever possible. Despite this, Judge O’Connor held that the entire law must fall with the individual mandate.

This decision will be appealed to the 5th Circuit, which is one of the most conservative in the country, and likely to the U.S. Supreme Court. A similar case is also pending in Maryland. So far, there is no immediate impact of this case and HHS has reassured people that 2019 coverage through the Exchanges will not be affected. But much remains uncertain.