NAMI Advocacy: Recent ACA court decision and what it means

In December 2018, U.S. District Court Judge Reed O’Connor in Fort Worth, TX issued a ruling, in the case Texas v. United States, that the entire Affordable Care Act (ACA) is unconstitutional.

What does this mean for people’s coverage?

No one will lose their coverage or have protections stripped away because of this ruling at this time.

The ruling will be appealed and could be overturned. In the meantime, the White House issued a statement that read, “We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place.”

What could this ruling mean?

The invalidation of the ACA, if upheld on appeal, would touch nearly every corner of the health care system and affect virtually every American. If upheld, this would be devastating for people with mental illness:

  • Millions of individuals and families covered through the ACA’s Medicaid expansion, including people with mental illness, would lose their coverage.
  • Millions of individuals who purchase individual or small group health insurance plans would lose important protections—and could even lose their coverage. These plans would no longer be required to: 
    • Cover preexisting conditions, like mental illness;
    • Guarantee coverage to everyone who applies;
    • Charge people with mental illness the same price as others for the same plan;
    • Provide parity coverage for mental health and substance use conditions;
    • Cover conditions without lifetime and annual limits; and
    • Cover mental health medications the same way they cover other medications.
  • Medicare beneficiaries would lose free coverage of important preventive services and could see the Part D prescription drug “donut hole” reopen, imposing higher drug costs.
  • Americans who have health insurance through their employer would
    • Lose their right to preventive services;
    • Lose coverage of children to age 26; and
    • See lifetime and annual dollar limits of coverage reappear.

NAMI will continue to monitor this situation and fight against efforts to turn back the clock to a time when health insurance plans discriminated against people with mental illness.

Hannah Wesolowski
Director of Field Advocacy 
Advocacy & Public Policy

NAMI, National Alliance on Mental Illness
3803 N. Fairfax Dr., Suite 100
Arlington, VA 22203
Main: 703-524-7600
Direct: 703-516-7962

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