Even though U.S. Northern District of Texas Court Judge Reed O’Connor struck down the Affordable Care Act (ACA or Obamacare), there are three good reasons to neither panic nor change your medical practice’s policies or your medical coding.

Judge O’Connor ruled the law as unconstitutional, agreeing with 20 state attorneys general that the Individual Mandate must work together with other provisions for the ACA to work as intended.  By bringing the ACA penalty down to $0, the attorneys argued, the 2017 Tax Cuts and Jobs Act stopped the individual mandate from functioning as a tax. With no tax link, this made the mandate and all of the ACA unconstitutional, they said.

But despite the December 14 decision, which threatens to upend coverage for millions of Americans and throw the healthcare industry into a death-defying skid, ACA remains the law of the land. How can that be?

1. It will be played out in the courts – Judge O’Connor’s decision is not an injunction requiring ACA-related activities stop immediately but a declaratory judgment. This is good news for members who have signed up for the exchanges, patients with pre-existing conditions, and benefit from ACA-spawned tax credits. Instead, his decision leaves the ACA operating until it is, presumably, appealed up higher courts to the U.S. Supreme Court.Expect an appeal soon to the Fifth Circuit Court of Appeals. Several state attorneys general and industry and patient advocacy associations and corporations challenged the original lawsuit. They will no doubt appeal.
2. Obamacare is in all of healthcare – Centers for Medicare & and Medicaid (CMS) Administrator Seema Verma assured Obamacare beneficiaries in a tweet that “There is no impact to current coverage or coverage in a 2019 plan.”  This not only speaks to the future of legal wrangling but to the far-reaching elements of the ACA. The law also mandates wholesale improvement to the healthcare system, including a switch from quantity to quality and efficacy, new healthcare delivery systems, and new roles for provider, payers, and patients.  Implementation of the law is eight years old and, in the same way it takes a railroad train three miles to stop, Judge O’Connor’s decision cannot bring a halt to the ACA quickly or easily.
3. People like what the ACA does for them – Ask even your most negative uncle about benefits like free colonoscopies and annual physicals, and he’ll probably tell you he likes them.  And he’s not alone. According to the Kaiser Health Tracking Poll, the public’s view of Obamacare has shifted dramatically more positive since October 1, when 49 percent viewed it favorably compared to 42 percent who disliked it. In late December 2018, the figures had shifted to 53 percent favorable and 40 percent unfavorable overall and 55 percent favorable for those in the $40,000-$89,999 income bracket. Women favor the law by 56 percent.Democrats made the protection of preexisting conditions a keystone of their 2018 midterm campaign, and it seemed to work. Voters cited their fears that protections could be overturned in their voting decisions, and talk of Medicare for All gained traction.  The newly elected Democratic House and a stronger Democratic base in large states like California might provide a parachute should the Supreme Court agree with Judge O’Connor.

Regardless, the drama of the ACA will continue for some time, and the law itself will continue to carry momentum for as long or longer.