Affordable Care Act Ruled Unconstitutional. So Now What Happens?

U.S. District Court Judge Reed O’Connor agreed with a group of 20 states with Republican governors or legislatures that argued the constitutionality of the law’s individual mandate dissolved when Congress removed the tax penalty for the uninsured.

In 2012, the Supreme Court upheld the law and its mandate requiring people purchase insurance on the grounds that it fell within Congress’ taxation power. O’Connor said when the tax penalty was removed, so was the central argument upholding the 2010 law’s constitutionality. His ruling declared not only the individual mandate, but the entire law, unconstitutional.

That decision leaves Republican and Democratic lawmakers, as well as millions of Americans, wondering, “So, what happens now?”

For the immediate future, the answer is nothing. The ACA will remain in place while the law’s future is handled in the courts, a process which could take months or years to resolve. People who bought coverage on the health care exchanges before Saturday’s deadline will be insured for 2019.

The case would go to the U.S. Court of Appeals for the 5th Circuit, which is dominated 11-5 by judges who were nominated by Republican presidents. Yale Law professor Abbe Gluck said the 5th Circuit will almost certainly grant a stay, keeping O’Connor’s ruling on hold pending their decision.

A three-judge panel for the 5th Circuit will then accept briefs and hear oral arguments in the case before giving their decision. From there, it’s possible the entire panel of 5th Circuit judges will ask to review the case.

“You’d be lucky if you had an opinion out of them before June,” Gluck said.

If O’Connor’s ruling is upheld, on the other hand, the Supreme Court “will have to take the case.” Barring a rare special session to hear the case, Gluck said it is most likely the Court will hear arguments in the case in early October.