Op-Ed: Healthcare isn’t a game. The Texas ACA lawsuit could be catastrophic for public health


Since the Affordable Care Act was signed into law in 2010, America’s access to healthcare has improved dramatically. Roughly 20 million Americans have gained health insurance coverage. Medicare beneficiaries can now get free preventive care and pay less for prescription drugs. And no one can be denied coverage based on preexisting conditions.

And yet, a group of 20 Republican governors and attorneys general are trying to accomplish in court what Republican lawmakers repeatedly failed to do in Congress: removal of the ACA and its vital protections for consumers.

Texas and 19 other red states filed the federal lawsuit, Texas vs. Azar, in February. They argue that because Congress eliminated the individual mandate penalty as part of last year’s tax bill, the mandate is no longer a tax; that the mandate is therefore unconstitutional; and that the entire ACA must be thrown out.


In an almost unprecedented move, the Justice Department then announced in June that it was abandoning its obligation to defend the ACA in court, saying it agreed with the premises of the lawsuit. California Attorney General Xavier Becerra’s office and other Democratic attorneys general will defend the law instead. Federal courts in Texas are some of the most conservative in the country, so it’s possible the case could advance to the U.S. Supreme Court. Oral arguments are scheduled to begin this week in Texas.

Health insurance isn’t the only vital benefit at risk. Eliminating the ACA will also cause steep cuts to critical public health programs.

I cannot overstate how much this lawsuit threatens individual and public health. Numerous studies have established definitively that health insurance improves health. According to the New England Journal of Medicine, health insurance provides “significant, multifaceted and nuanced benefits to health.” The American Journal of Public Health has reported that people who do not have health insurance die prematurely.

Overturning the ACA will result in a catastrophic loss of coverage for millions of Americans. According to a new analysis by the Urban Institute, if the ACA is invalidated, more than 17 million people would lose coverage in 2019. That would be a 50% increase in the number of uninsured in just one year, including 12 million people who receive insurance through the marketplaces created by the ACA and 2.3 million young adults who gained coverage through its expansion of dependent care.

Striking down the ACA will jeopardize the healthcare of those who need it most. Nearly 12 million low-income Americans who were enrolled in Medicaid through the ACA would likely lose coverage. And many families will lose the protections that currently prevent insurance companies from denying care to people with preexisting conditions. Some will be denied coverage because they have diabetes, hypertension, cancer or heart disease, or simply because they had asthma as a child.

Health insurance isn’t the only vital benefit at risk. Eliminating the ACA will also cause steep cuts to critical public health programs.


The ACA has provided more than $8 billion in funding for broad public health services and disease prevention programs through what’s called the Prevention and Public Health Fund. These resources have supported efforts to immunize children, ensure our water is safe to drink, help people quit smoking and prevent drug addiction. This includes services that are critical to stemming our national opioid epidemic.

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The law has also provided resources for developing and testing new ways to improve the quality of the healthcare provided through insurance. This, too, could be lost.

According to a widely cited Gallup poll, a majority of Americans worry “a great deal” about the availability and affordability of healthcare. They are right to worry, especially with the ACA under attack.

This lawsuit could be the most dangerous effort to destabilize the American healthcare system yet. That’s why the American Public Health Association has submitted friend-of-the-court briefs opposing this suit, along with many other health organizations, insurers, economists and members of the business community.

The Trump administration and its supporters are playing politics with the health of the American people. Healthcare isn’t a game. Millions of Americans have too much to lose.

Georges C. Benjamin is the executive director of the American Public Health Association.

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