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Member Research and Reports

Member Research and Reports

UNC: Expert Perspective – Legislative Gridlock Leaves Affordable Care Act in Limbo

In a Perspective column for the New England Journal of Medicine, Dr. Jonathan Oberlander, professor of health policy and management at the University of North Carolina Gillings School of Global Public Health, explores the challenges a divided government poses for the future of the Affordable Care Act (ACA).

Dr. Oberlander’s column, “Sitting in Limbo — Obamacare under Divided Government,” appeared online in the journal May 9. At issue are the legal ramifications of repealing the ACA “tax” on individuals who lack health insurance coverage.

In 2018, Republican state attorneys general made the case, upheld in district court, that the ACA “tax” was not separate from the law and that Congress had therefore rendered the entire ACA unconstitutional by eliminating the tax. The Fifth Circuit of the United States Court of Appeals is expected to reverse this ruling, and the case eventually could go to the U.S. Supreme Court.

“That Republican officials still seek to repeal the entire ACA despite the risk of enormous electoral damage to the GOP should they prevail underscores the persistence and intensity of opposition to Obamacare in some quarters,” Dr. Oberlander states. “In this struggle, the courts have become another arena for partisan conflict. Ultimately, Texas v. Azar may reveal less about constitutional law than it does about ACA politics.”

Dr. Oberlander also writes that — outside of the courts — legislative gridlock has left the ACA in limbo, making it difficult to either improve upon or repeal it.

“Democrats have been unable to strengthen or build on the ACA, and Republicans have been unable to eliminate or severely weaken it,” Dr. Oberlander states. “Barring a stunning Supreme Court decision to invalidate the entire ACA, the stalemate will continue until at least 2021.”

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