On Friday, December 14, 2018, a Texas federal judge issued a ruling that found the entire Patient Protection and Affordable Care Act (“ACA”) unconstitutional. The lawsuit, Texas v. United States, was brought by Texas Attorney General Ken Paxton, along with 17 other attorneys general and 2 governors, as the latest attempt to challenge the constitutionality of the ACA. The defendants in this case were California Attorney General Xavier Becerra and 16 Democratic state attorneys general. Judge Reed O’Connor of the Northern District of Texas ruled in favor of the plaintiffs, holding that the individual mandate is no longer valid under Congress’ taxing power. Judge O’Connor also found the individual mandate “essential” and “inseverable” from the rest of the ACA, invalidating the entirety of the federal health care law, not just the individual mandate. An injunction was not granted at the time of the decision. However, the judge subsequently stayed the holding in the case pending appeal. This means there will not be any immediate disruptions in the U.S. health care system.
If this decision is upheld and the ACA is struck down, there would be far-reaching effects across the U.S. health care system. Protections for people with preexisting conditions would be eliminated, affecting access to rehabilitative and habilitative care. This case leaves the future of the ACA unclear. However, the defendant attorneys general are moving to start the appeal process. If the decision is upheld on appeal, the case will head to the Supreme Court in 2020.
The Academy is following this issue closely – independently and through its work with various coalitions – including the Independence Through the Enhancement of Medicare & Medicaid (ITEM) Coalition, Coalition to Preserve Rehabilitation (CPR), Consortium for Citizens with Disabilities (CCD) Coalition, and the Habilitation Benefits Coalition (HAB) to preserve rehabilitation programs. AAPM&R would like to thank Powers, Pyles, Sutter, and Verville (PPSV), the Academy’s lobbying firm for providing the case analysis.
 Texas v. United States (Memorandum Opinion), No. 4:18-cv-00167-O (W.D. Tex. Dec. 14, 2018).
 Complaint, Texas v. United States, No. 4:18-cv-00167-O (W.D. Tex. Feb. 26 2018).
 The Intervenor-Defendant states are California, Connecticut, Delaware, Hawaii, Illinios, Kentucky Massachusetts, Minnesota, New Jersey, New York, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia.