During the heated campaigning of last fall's midterm elections, the White House and officials from both parties pledged that people with preexisting health conditions would not lose the safeguards afforded by the Patient Protection and Affordable Care Act (ACA).
This month, the Academy and five peer medical organizations charged in a March 27 statement(www.groupof6.org) that the administration had broken that promise.
The Group of Six(www.groupof6.org) spoke out in response to a March 25 letter(www.healthleadersmedia.com) from the Department of Justice (DOJ) to the U.S. Court of Appeals for the Fifth Circuit. In that two-sentence letter, the administration -- which last year said it would cease defending the ACA in court -- announced that it now plans to argue against the law.
Referring to a judgment issued in December by U.S. District Judge Reed O'Connor in Texas et al. v. United States et al.,(www.texasattorneygeneral.gov) that the ACA has become unconstitutional, the letter reads, in full: "The Department of Justice has determined that the district court's judgment should be affirmed. Because the United States is not urging that any portion of the district court's judgment be reversed, the government intends to file a brief on the appellees' schedule."
O'Connor's ruling in the case, which was brought by 20 state attorneys general seeking to strike down the ACA, said the law became unconstitutional once Congress eliminated the tax penalty imposed on people who do not obtain health insurance -- the ACA's "individual mandate."
The AAFP voiced strong disagreement with that decision.
This latest reversal, the Group of Six said in its statement, "would endanger not only essential protections for persons with preexisting conditions, but other programs that millions of Americans depend on to ensure their access to affordable health care." Among these crucial items now in jeopardy: federal funding for Medicaid expansion, premium subsidies to make coverage affordable in the individual market, and the ACA's ban on annual and lifetime coverage limits.
The AAFP was joined in the statement by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association, and the American Psychiatric Association
In a separate statement, AAFP President John Cullen, M.D., of Valdez, Alaska, said the administration's courtroom sabotage of the ACA "should alarm everyone."
"The ultimate outcome of this case will determine whether tens of millions of Americans will have access to necessary -- and often lifesaving -- medical care," he added.
In December, when O'Connor ruled against the ACA, Cullen warned that patients could expect a "profoundly negative impact" if that judgment survived its inevitable appeal. The DOJ's new position brings that threat to U.S. health care closer to reality. On April 1, the Academy joined more than a dozen other organizations in an amicus curiae brief(59 page PDF) defending the ACA. To strike down the entire law, the brief said, would cause “havoc” in the U.S. health care system.
Cullen, in his latest statement, said that the Academy "would support legislative efforts to improve the ACA by expanding coverage and making services more affordable. However, eliminating the ACA is not the way to accomplish this.
"The AAFP will be steadfast in our support of patient protections as we continue to work for policies that ensure our patients get the care they need, when they need it," he pledged.