What is the next step for the Affordable Care Act?

This decision leaves Republican and Democratic lawmakers, as well as millions of Americans, wondering: "So what's going on now?"

For the immediate future, the answer is nothing. The ACA will remain in place while the future of the law will be dealt with by the courts. A process could take months or even years to resolve. People who purchased coverage on the health bursaries before the Saturday deadline will be insured for 2019.

President Trump: The decision against Obamacare offers another chance to repeal and to replace

. "Republicans will never stop": Obama condemns GOP after being ruled against the Affordable Care Act

The Legal Battle

The Department of Justice President Donald Trump announced in June that he would not defend the ACA individual. mandate and other provisions, such as protections for people with pre-existing illnesses, but requested that the law not be rescinded in its entirety.

It is therefore unlikely that the Department of Justice will appeal O Connor's decision. But after the Trump government abandoned its defense of the ACA, a number of Democratic states, led by California, took over the torch. These states intend to appeal Friday's decision.

"The ACA has survived more than 70 unsuccessful attempts to repeal and has not stood up to scrutiny in the Supreme Court, and today's erroneous decision will not deter us: our coalition will continue to fight in court for the health and well-being of all Americans, "California Attorney General Xavier Becerra said Friday in response to the ruling.

House Minority Leader Nancy Pelosi, D-Calif., Promised that the Democrats would intervene and ask the lawyers in the House to defend the ACA when they would take control of the room next month.

The case would go to the US Court of Appeals. for the 5th Circuit, which is dominated 11-5 by judges who were nominated by the Republican Presidents. Yale's law professor, Abbe Gluck, said the 5th circuit would almost certainly grant a suspension, keeping O & # 39; Connor's decision pending pending their decision.

A panel of three fifth circuit judges will then accept the briefs and hear the pleadings in the case before rendering its decision. From there, it is possible that the entire panel of judges of the 5th Circuit asks to examine the case.

"You'd be lucky if you had an opinion about them before June," said Gluck.

Whatever the decision of the 5th circuit, one party or the other is almost certain to appeal. But Gluck said she thought the "current Supreme Court would not accept the case" if O Connor's decision was overturned because "the case is extremely weak on the legal plan and I do not think anyone at court has the appetite of another politicized Obamacare "

If the decision of O. Connor is upheld, however, the Supreme Court" will have to seize the case. "Gluck stated that it was highly likely that the court would hear the pleadings early in October, with the exception of a rare extraordinary session of hearing.

Divisibility

Gluck, who described the decision as "shocking" in an editorial published in the New York Times and whose co-author, Johnathan Adler, professor of law at the Faculty of Law of the New York Times. Case Western Reserve University, expects the case to be overturned and will never succeed in making it the Supreme Court.

"This case is based on a very simple and well established legal principle, which conservative and liberal judges apply," she said. This principle, called "divisibility", is that when a court declares part of a law unconstitutional, the rest of the law should remain in force "unless Congress clearly decides otherwise. ".

"Sometimes the cases of divisibility are difficult because it is hard to guess the importance that Congress attributes to a provision, especially in a law as long as the Affordable Care Act," Gluck and Adler wrote in the statement. Times. "But it's an easy case: it's Congress, not a court, that has removed the warrant and left the rest of the statute in. How can a court find that Congress never wanted the rest of the status to exist without an operational mandate? mandate, while it was the 2017 Congress itself that decided it was good to eliminate the penalty and leave the rest of the law intact? "

O. Connor stated that congressional Republicans had abolished the tax penalty but left the rest of the law untouched because they did not have the vote for a complete repeal.

Gluck and Adler described this argument as "ridiculous" and stated that the intention of Congress should be determined by its vote.

"Congress thinks that the law operates without an operational mandate.Creating the opposite, it is to assume that Congress adopts impracticable laws and this is not what the courts are allowed to presume", did they write.

Market Effect

The legal uncertainty around the law could have negative effects on the health insurance markets, said Jill Horwitz, a law professor at UCLA.

"Insurance markets depend on stability," he said. "This kind of turbulence creates an uncertain legal environment in which insurance companies do not like to operate."

Instability makes it difficult for managers of insurance companies because they do not know if the exchanges will take place. continue to operate or how many people will be eligible to make their purchases, Horwitz said.

"Rates are set for next year, but I imagine that this kind of uncertainty will only cause prices to rise for the next year", she said.

"And if it's hard for experts to keep up with all the twists and turns of the state of the ACA, imagine how difficult it is for someone who is working full-time time, trying to live his life, is not an expert in insurance markets, without the help of awareness, because we have reduced the funding of registration advisors, "Horwitz said. "Imagine how difficult it is for these people to find insurance."

Although Mr. O. Connor's decision was overturned by the 5th Circuit or the Supreme Court, Mr. Horwitz stated that there could be three reasons for the markets to experience price increases.

"One is that insurance companies simply do not like to live in this type of uncertainty and will therefore incorporate this uncertainty into their products," he said. she declared.

The second risk is that consumers "pass the wrong message" and, without major awareness raising, fewer of them will go to the insurance markets.

Third, it could mean that "instead of spending their time improving the health system for the people who need it, policymakers spend their time pleading the case".

To learn more: The Trump administration promises a 2019 drop in average Obamacare premiums after sharp increases this year

Searching for a legislative solution

The Solution Providing Greater Stability and Predictability for Both Insurances President Donald Trump told reporters that "assuming the Supreme Court upholds its decision, we would get very good health care for our people," he said. Horwitz. "We will have to sit down with the Democrats to do it, but I'm sure they want to do it too."

Democrats will no doubt want to pass legislation on health care, but they will have to agree with Trump and the Senate. Republicans on the details will be a challenge.

A call to "Medicaid for all" and expand an option of public insurance is popular among Democrats. Health insurance and continued coverage for people with pre-existing conditions was a central campaign issue for Democrats, who won a majority in the House in the mid-term elections.

And Democrats think they have a political advantage in the debate. As the future President Pelosi will likely be able to order the House Lawyer to intervene in the CAA without a vote. But she intends to bring one anyway to register the Republicans, reported Politico. Schumer announced Sunday that he intended to lobby for a similar vote in the Senate, for similar reasons.

But these Democrats in the House will need the Republican-controlled Senate to take all necessary steps to make it Trump's office over the next two years and "Medicaid for all" will probably not have the same appeal from one side to the other.

Republicans are more willing to maintain the provisions of the Affordable Care Act since their unsuccessful efforts to "repeal and replace" the law and some have suggested a more gradual approach.

Insurance for people with pre-existing diseases is an area in which Republicans and Democrats could work together. Other popular provisions, such as the ability for parents to keep their children in their diets until the age of 26, could also be enacted as separate legislation.

Sen. Susan Collins, R-Maine, said Sunday that O Connor's decision was "far too radical" and that she thought "the decision will be rescinded".

"There are many good provisions in the law that should be kept," said Collins.

Law professor Gluck is pleased that Collins and other lawmakers recognize the low legal status of the O & Connor decision, but fear that this will lead to inaction.

"It is good that legal experts hear so much about the fact that the decision will probably be overturned and I am happy that the message is transmitted," she said. "I think this message is likely to spread to the point of giving Congressmen and the White House the impression that they can just sit and do nothing."

Contribution: Richard Wolf

More: While the Republicans are trying to end Obamacare, the uninsured rate remains unchanged in the first year of Trump