Nos. 19-840, 19-1019 In The CALIFORNIA, ET AL., Petitioners, v. TEXAS, ET AL., Respondents. TEXAS, ET AL., Petitioners, v. CALIFORNIA, ET AL., Respondents. ON WRITS OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT BRIEF OF AMERICA’S HEALTH INSURANCE PLANS AS AMICUS CURIAE IN SUPPORT OF CALIFORNIA, ET AL., AND U.S. HOUSE OF REPRESENTATIVES Julie Simon Miller Pratik A. Shah Thomas M. Palumbo Counsel of Record AMERICA’S HEALTH Z.W. Julius Chen INSURANCE PLANS AKIN GUMP STRAUSS 601 Pennsylvania HAUER & FELD LLP Avenue, NW 2001 K Street, NW South Building, Suite 500 Washington, DC 20006 Washington, DC 20004 (202) 887-4000 [email protected] Counsel for Amicus Curiae TABLE OF CONTENTS INTEREST OF AMICUS CURIAE ............................. 1 INTRODUCTION AND SUMMARY OF ARGUMENT ................................................................ 2 ARGUMENT .............................................................. 11 A. Wholesale Invalidation Of The ACA Would Result In Massive Disruption To Patients And Other Health Care Stakeholders ................................................... 11 1. The ACA is sweeping in its scale and scope. ......................................................... 11 2. Invalidation of the ACA would have serious consequences in disparate areas wholly untethered to the individual mandate.................................. 17 a) Individual Market ............................ 18 b) Group Plans ...................................... 21 c) Medicaid ........................................... 23 d) Medicare ........................................... 26 B. The ACA’s Preexisting-Condition Provisions Would Continue To Function Properly Without The Mandate In Today’s Individual Market ............................. 29 CONCLUSION .......................................................... 34 (i) ii TABLE OF AUTHORITIES CASES: National Fed’n of Indep. Bus. v. Sebelius, 567 U.S. 519 (2012) .............................................. 33 STATUTES AND REGULATIONS: 26 U.S.C. § 4980H(a) ............................................................ 22 42 U.S.C. § 300gg-1 ................................................................. 9 § 300gg-3 ................................................................. 9 § 300gg-4 ................................................................. 9 § 18091(2)(I) .......................................................... 30 CAL. HEALTH & SAFETY CODE § 1399.811(c)(2) .................................................... 20 CAL. INS. CODE § 10901.9(c)(2) ...................................................... 20 Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029.................................................... 1, 28, 29 LA. REV. STAT. ANN. § 22:1098 ............................................................... 20 Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010) ............. 1 26 C.F.R. § 1.36B-2 ............................................................... 19 iii OTHER AUTHORITIES: Antonisse, Larisa et al., The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review, KAISER FAMILY FOUND. (Mar. 28, 2018) ............................................................... 17, 24 Berchick, Edward R. et al., Health Insurance Coverage in the United States: 2018 (Nov. 2019) ................................................... 22 Buchmueller, Thomas C. & Helen G. Levy, The ACA’s Impact on Racial and Ethnic Disparities in Health Insurance Coverage and Access to Care, 39 HEALTH AFF. 395 (2020) .................................................................... 14 Buntin, Melinda Beeuwkes & John A. Graves, How the ACA Dented the Cost Curve, 39 HEALTH AFF. 403 (2020) ................ 15, 32 Center on Budget & Policy Priorities, Chart Book: Accomplishments of Affordable Care Act (Mar. 19, 2019) ................................ 13, 14 Centers for Disease Control & Prevention, Prevention and Public Health Fund (last visited May 11, 2020) ........................................... 16 Centers for Medicare & Medicaid Services, Early 2019 Effectuated Enrollment Snapshot (Aug. 12, 2019) ..................................... 19 iv Centers for Medicare & Medicaid Services, Effectuated Enrollment for the First Half of 2019 (Dec. 11, 2019) ......................................... 13 Centers for Medicare & Medicaid Services, Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Contract Report—Monthly Summary Report (Apr. 2020) ..................................................................... 27 Centers for Medicare & Medicaid Services, Press Release, Federal Exchange Enrollment Remains Stable for the Third Consecutive Year in a Row (Dec. 20, 2019) ..................................................................... 31 Centers for Medicare & Medicaid Services, Press Release, Premiums for HealthCare.gov Plans Are Down 4 Percent but Remain Unaffordable to Non-Subsidized Consumers (Oct. 22, 2019) ..................................................................... 31 Congressional Budget Office, H.R. 1628, Obamacare Repeal Reconciliation Act of 2017 (July 19, 2017) ........................... 17, 19, 20, 24 Congressional Budget Office, Repealing the Individual Health Insurance Mandate: An Updated Estimate (Nov. 2017) ....................... 31 Conti, Rena et al., How the ACA Reframed the Prescription Drug Market and Set the Stage for Current Reform Efforts, 39 HEALTH AFF. 445 (2020) ........................... 16, 26, 28 v Corlette, Sabrina et al., The ACA’s Effect on the Individual Insurance Market, 39 HEALTH AFF. 436 (2020) ....................... 7, 14, 32, 33 COVID-19 Impact on Medicaid, Marketplace, and the Uninsured, by State HEALTH MGMT. ASSOCS. (2020) .......................... 7, 8 Department of Financial Services, New York State, Press Release: Proposed 2019 Health Insurance Premium Rates for Individual and Small Group Markets (June 1, 2018) ....................................................... 32 Forsberg, Vanessa C., Overview of Health Insurance Exchanges, CONG. RESEARCH SERV. (June 20, 2018) ........................................... 23 Garrett, Bowen & Anuj Gangopadhyaya, How the COVID-19 Recession Could Affect Health Insurance Coverage, ROBERT WOOD JOHNSON FOUND. (2020) ............ 6, 8 Kaiser Family Foundation, Health Reform Glossary (last visited May 11, 2020) ................... 22 Kirzinger, Ashley & Mollyann Brodie, When Will the Unemployed Go Back to Work? Many Laid Off Workers Expect To Get Jobs Back in the Short-Term but Experts Caution About Long-Term, KAISER FAMILY FOUND. (May 4, 2020) ................................ 6 vi Looney, Adam & Kathryn Martin, One in Five 2014 Marketplace Consumers Was a Small Business Owner or Self-Employed, U.S. DEP’T OF THE TREASURY: TREASURY NOTES BLOG (Jan. 12, 2017) ................................. 23 Medicaid & CHIP Payment Access Commission, Issue Brief, Medicaid Spending for Prescription Drugs (Jan. 2016) ..................................................................... 26 Medicaid & CHIP Payment Access Commission, Medicaid Enrollment Changes Following the ACA (last visited May 11, 2020) ................................................. 13, 24 Medicaid Program: Eligibility Changes Under the Affordable Care Act of 2010, 77 Fed. Reg. 57 (Mar. 23, 2012) ........................... 25 Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy (Mar. 15, 2018) ........................... 29 National Conference of State Legislatures, 2011-2014 Health Insurance Reform Enacted State Laws Related to the Affordable Care Act (updated June 17, 2014) ..................................................................... 12 vii Office of the Health Insurance Commissioner, State of Rhode Island, Press Release: 2019 Requested Commercial Health Insurance Rates Have Been Submitted to OHIC for Review (May 30, 2018) ......................................... 32 Searing, Adam, Study Documents How Medicaid Expansion Helps Keep Rural Hospitals Open, GEORGETOWN UNIV. HEALTH POLICY INST. (Jan. 12, 2018) .................. 16 Soni, Aparna et al., How Have ACA Insurance Expansions Affected Health Outcomes? Finding from the Literature, 39 HEALTH AFF. 371 (2020) ............................ 14, 15 U.S. Census Bureau, Health Insurance Coverage in the United States: 2018 (Nov. 2019)............................................................ 11 U.S. Department of Health & Human Services, Fiscal Year 2017, Budget in Brief (Feb. 2016) ................................................... 23 Uberoi, Namrata et al., Issue Brief: Health Insurance Coverage and the Affordable Care Act, 2010-2016, ASPE (Mar. 3, 2016) .................................................................... 13 INTEREST OF AMICUS CURIAE1 America’s Health Insurance Plans, Inc. (“AHIP”) is the national trade association representing the health insurance community. AHIP advocates for public policies that expand access to affordable health care coverage to all Americans through a competitive marketplace that fosters choice, quality, and innovation. Along with its predecessors, AHIP has over 60 years of experience in the industry. AHIP’s members provide health and supplemental benefits through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. As a result, AHIP’s members have broad experience working with virtually all health care stakeholders to ensure that patients