A U.S. District Court ruling late last week threw into doubt the Affordable Care Act, declaring the entire health insurance access law unconstitutional.

The ruling in Texas v. Azar is almost certain to be appealed, and for now, the ACA remains in effect. The U.S. Department of Health and Human Services has announced it will continue administering and enforcing “all aspects of the ACA.”

Colorado, meanwhile, has its own health insurance exchange marketplace, Connect for Health Colorado. Additionally, state law protects people with preexisting conditions, said Linda Gann, senior manager of the Connect for Health’s Western Slope region.

“The question is, does the new ruling affect people who already have coverage through Connect for Health? This ruling does not. The decision is the first step in a long process,” Gann said, noting the ruling in Texas v. Azar is stayed, pending appeal.

As for 2019? “Right now, nothing will change. The process could take a long time. The health insurance people buy now cannot be changed as long as people continue to make their premiums,” Gann said.

The ruling does not change protections for preexisting conditions for Colorado residents, the state Division of Insurance said.

“Guaranteed health insurance coverage for people with preexisting conditions is enshrined in Colorado law,” Interim Insurance Commissioner Michael Conway said in a Dec. 14 statement.

“The Division of Insurance will continue to enforce Colorado law and maintain this important protection for our citizens.”

The division oversees health insurance companies and premium prices through the state exchange.

“Colorado has its own law that is in effect (for preexisting conditions). So that part of Colorado law, which is not part of the Texas case, remains in force. Coloradans with preexisting conditions are protected,” Gann said.

The Affordable Care Act, also called Obamacare, required Americans to be insured, or pay a penalty. The U.S. Supreme Court previously ruled the mandate constitutional, finding it was a tax and Congress has the authority to levy taxes.

According to published reports, however, that penalty was abolished as part of last year’s tax reform and attorneys general in 20 states argued in Texas v. Azar that the mandate was no longer a tax; therefore, the ACA itself would be unconstitutional.

U.S. District Judge Reed O’Connor in his Dec. 14 ruling agreed.

“The court finds the individual mandate can no longer be fairly read as an exercise of Congress’ tax power and is still impermissible under the interstate commerce clause — meaning the individual mandate is unconstitutional,” O’Connor stated in his opinion, in which he also found the mandate to be “in-severable from the remainder of the ACA.”

The ruling, coming just hours before the Dec. 15 ACA enrollment deadline, prompted immediate debate in legal circles. Among ACA backers, it drew swift rebuke.

Although the decision will not immediately affect coverage nationally, it throws the health coverage system into chaos, Adam Fox, director of strategic engagement for the Colorado Consumer Health Initiative, said in a news release from the initiative, which represents more than 45 Colorado health organizations and bills itself as an advocacy organization for affordable, equitable health care for state residents.

Fox called the District Court ruling an “unprecedented attack” that could end up costing 600,000 Coloradans their health coverage.

“Additionally, the ruling, as it stands, would eliminate both the ACA’s Medicaid expansion provision and the availability of federal assistance for coverage in the individual market, putting health coverage and care beyond the reach of many,” Fox said, calling for a swift reversal by federal appellate courts.

Coloradans should, however, continue to enroll in coverage, because there is no immediate effect on health insurance options during the appeal, he said.

Gann said that while the appeal is in process, it is important that people know they can still receive coverage — and that the tax credits that help income-eligible individuals pay for it remain in effect.

“It’s so important to have peace of mind, knowing they are protected,” she said.

Colorado, with its own marketplace that was established as a quasi-nonprofit, has a bit more flexibility than states that do not have their own exchange, Gann said.

The state’s open enrollment period extends through Jan. 15; the deadline elsewhere was Dec. 15. Those who signed up by the earlier date will have coverage effective Jan. 1; those enrolling Dec. 16 - Jan. 15 will not be covered until Feb. 1, giving them 11 months of coverage instead of 12. However, in Colorado, people still have the extra 30 days to enroll.

“That’s one of the other benefits and wisdom of the bipartisan legislation that created Connect for Health,” said Gann.

“We’ll continue to implement the law as it is written. Right now, the ACA is still law.

“Beyond that, we’ll have to wait and see what happens. We’ll be watching, along with everyone else. It seems every year there is something that provides challenges or opportunities for people to get covered.”

In Colorado, enrollments are up 5 percent over last year, and despite the uncertainty at the federal level, people continue to sign up, she added.

“We’re going to be really working hard to ensure people understand they can still get coverage for 2019,” Gann said.

County-specific numbers for the year are not yet available. Montrose County is among rural areas where only a few carriers offer plans through the state exchange — there is one here, Anthem, which offers eight different plans.

“That’s one of the things that I think will be part of the Colorado legislative agenda when they convene — what can happen to increase competition, particularly on the Western Slope,” Gann said.

“We’ll be watching the federal landscape, but certainly, what happens in Denver. The state has some flexibility in how they can build health policy. It will be an interesting year ahead.”

More information about enrollment and plans through the state health care exchange can be found at connectforhealthco.com.

Katharhynn Heidelberg is an award-winning journalist and the senior writer for the Montrose Daily Press.w her on Twitter @kathMDP.

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