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Affordable Care Act may be headed back to Supreme Court

A sign directing people to an insurance company where they can sign up for the Affordable Care Act. Photo: Joe Raedle/Getty Images

The Affordable Care Act, President Obama's signature achievement, may be headed back to the Supreme Court after a conservative federal judge in Texas struck down the individual mandate as unconstitutional last evening.

Be smart: This really could end with the Affordable Care Act being wiped out. There’s no guarantee that a more conservative Supreme Court won’t just let the law die.

A White House statement said: "We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place."

  • "The ruling was over a lawsuit filed this year by a group of Republican governors and state attorneys general," per the N.Y. Times.
  • U.S. District Court Judge Reed O’Connor in Fort Worth, a George W. Bush appointee, wrote that the individual mandate requiring people to have health insurance "can no longer be sustained as an exercise of Congress’s tax power."

The big picture: This was an amazingly broad ruling. The judge didn't just strike down everything that's related to the individual mandate. He struck down everything, period.

  • That includes the parts that everyone likes, like the expansion of Medicaid, young adults staying on their parents' plans — and, of course, coverage of pre-existing conditions.
  • Nothing happens right away. The ruling will be appealed, there's no injunction to shut down the law right now, and the Trump administration is making it clear the law stays in place for now.

Why it matters: You should take this ruling seriously. It's getting a lot of criticism from legal experts, including ACA critics, and it could be overturned — but it won't definitely be overturned. This really could end with the ACA being wiped out.

  • The ACA has already survived two near-death experiences with the Supreme Court — over the mandate in 2012 and subsidies in 2015.
  • But that was before the Kavanaugh Court. If this ruling gets that far, the justices could say the ruling went too far and overturn it.
  • But there’s no guarantee that a more conservative court won’t just let the law die.

Political fallout: This could be a nightmare for Republicans in suburbs and swing states.

  • The midterms proved that the ACA has gotten more popular since the GOP started trying to repeal it — especially the protections for pre-existing conditions.
  • If the law goes away, that goes with it. This is not the fight Republicans want to have.