Texas Court Holds Affordable Care Act Unconstitutional

Legislation | December 19, 2018 | by Barbara Gay

A federal district court in Texas handed down a decision December 14, 2018 in the case of Texas et al. vs. United States of America, holding the Affordable Care Act (ACA) unconstitutional in its entirety.

However, the case is still subject to further litigation and appeal, in all likelihood eventually going to the U.S. Supreme Court. According to legal experts, a final resolution of the case might not come until mid-2021.

In the meantime, CMS Administrator Seema Verma has indicated that all Affordable Care Act programs and initiatives will continue in operation. We do not anticipate the district court ruling will affect LeadingAge members or their residents and clients for at least the coming year.

Listed below are some of the most significant ACA provisions for aging services providers and the older people they serve, which could be nullified if all provisions of the ACA were invalidated through the judicial process. The actual impact of a final judicial ruling would depend on the specifics of the eventual decision and on any action Congress may take on the ACA while the case is still in litigation. Democratic members of Congress have already stated their plans to legislate protections for the Affordable Care Act next year.

Affordable Care Act provisions of interest to older adults and their caregivers:

  • Closure of the Medicare Part D prescription drug coverage gap (the so-called “doughnut hole”), plus the elimination of cost sharing for certain dual eligibles;
  • Medicare coverage of annual wellness visits for beneficiaries to obtain a personalized preventive health care plan and removal of barriers to Medicare coverage of preventive services;
  • Several options for expanding Medicaid coverage of home- and community-based services, including Money Follows the Person, Community First Choice, and protection against spousal impoverishment for home- and community-based services recipients;
  • Initiatives to make the delivery of health care and long-term services and supports more efficient and cost-effective, including improved coordination of Medicare and Medicaid-covered services for dual eligibles, health homes for individuals with chronic conditions, and the beginnings of value-based purchasing programs for skilled nursing facilities and home health;
  • Establishment of the Center for Medicare and Medicaid Innovation to develop new care models, which have included accountable care organizations, bundled payments, hospital readmission reduction programs, the Independence at Home demonstration program, community-based care transitions programs, and other models that reward quality and person-centered approaches to service delivery;
  • Medicare provider payment reforms, including payment methodology, changes for home health and hospice, the face-to-face encounter requirement for coverage of hospice services, the reduction of skilled nursing facilities’ annual Medicare payment update by the productivity adjustment factor; and more reasonable reimbursement of Medicare Advantage plans;
  • Transparency and program integrity initiatives that brought new additions to Nursing Home Compare and the Five Star rating system; changes to the civil monetary penalties requirements, and a nationwide program for national and state background checks of direct care workers in long-term care settings.
  • The face-to-face requirement for physicians to certify Medicare beneficiaries’ eligibility for coverage of home health and durable medical equipment;
  • Elder Justice Act provisions including the requirement that any reasonable suspicion of crimes against nursing home residents be reported within certain timeframes.