2014年，《平价医疗法案》为2000万美国人提供了平价医疗保险。同样重要的是，它创造了美国第一个非歧视性的保险市场，确保美国人不再是一个糟糕的事故或一个远离破产的坏基因。该法的一个关键部分是个人授权，其目的是鼓励广泛参与保险市场，并在国家交易所压低保费。
这条法律很有效。数百万人不仅获得了保险，而且数千万人晚上睡得更好，因为他们知道如果他们失去了保险，就不会因为先前的疾病而“无法投保”。国家交易所的溢价是16%低于2014年的预测，平均上升了大约8.6%在项目的前三年里，每年，远低于10%或更高。美国的整体医疗保健成本在2008年增长到了20%最慢速度在测量的历史中。
但这项授权不受欢迎。2017年，共和党领导的国会通过将相关的税收罚款设置为零，有效地取消了该法案。由于风险池不太健康，这预期会降低州交易所的注册人数，并大幅提高保费。然而，《反腐败法》虽然较弱，但仍在继续，目前有1700多万人因法律和不歧视等其他规定而受益。
现在，反腐败局本身也面临风险。在一项极具争议的裁决中，德克萨斯州的一家地区法院于2018年12月裁定，由于个人授权不再有效，整个反腐败法必须废除。德州北区的法官里德·奥康纳(Reed O'Connor)是众所周知的政府保守派反对者，两党的法律专家都指出，他的决定没有依据。
奥康纳认为，完全基于他自己的逻辑，授权不能与反腐败法“分离”——没有授权，法律就不再有效。这种推理与事实不符:该授权显然与反腐败局是分开的，事实证明，反腐败局在该授权被有效撤销后仍然运作良好。法官的论点也直接违背了国会的意图。国会有机会扼杀整个反腐败局，但没有——相反，只是简单地取消了授权。也就是说，国会本身已经清楚地表明，这项授权被视为与更大的法律是分开的。
然而，本周，上诉法院没有驳回法官的不当推理。法院只是把它发回给他，让他再试一次。第五巡回上诉法院的法官甚至在他们的报告中添加了一个如此政治化的随机脚注，这可能是我们总统的一句直接引语:“反腐败局的一些反对者声称，目标不是降低医疗保险成本，而是整个法律是作为对美国人民的欺诈行为的一部分而颁布的。”
面对不恰当的决定，这是完全放弃责任。上诉法官没有做出艰难的决定，而是很方便地打住，直到几乎可以肯定的2020年大选之后。
这对美国人的影响是可怕的。最近的研究表明通过扩大《反腐败法》的保险覆盖面，成千上万人的生命得以挽救。美国公民很大程度上支持消除保险市场的歧视。事实上，《反腐败法》中保留下来的部分——包括通过公共医疗补助计划和私人保险税收抵免使保险负担得起——广受欢迎。
7月9日，在华盛顿特区，国会的民主党议员手持美国人先前存在的健康状况的照片，出席了关于美国国会大厦台阶的新闻发布会
此外，反腐败法没有简单的替代办法。国会共和党人和特朗普政府向我们兜售了一个“废除并取代”的虚构故事，但在关于反腐败法案的辩论结束大约10年后，没有任何替代方案。国会为解决反腐败法案唯一认真的努力是在2000万到2000年间3200万没有保险的人——并且会重新引入保险公司歧视我们病情最重的邻居、朋友和家人的能力。与此同时，左翼试图用更大胆的措施来取代反腐败法，如单一支付者医疗保健，但几十年来一直没有成功，一旦这些计划的成本被理解，也没有得到广泛的公众支持。
这里颇具讽刺意味的是。记住，反腐败委员会的反对者经常警告说，它会“拿走你的保险”(事实上，大多数在《反腐败法》下“失去”保险的人是那些他们基本上不知道保险范围的人，这使他们面临着负担不起的医疗费用。)现在，取消《反腐败法》将导致更多的美国人失去真正有意义的保险。
围绕反腐败法案的十年斗争表明，无论好坏，立法应该如何运作。当一个政党控制了国会和白宫，它通过了一项法律。当另一方接管时，它试图废除该法律。发现自己做不到，它删除了一部分它不喜欢的法律。这应该是故事的结尾。
但是现在得克萨斯州的一名流氓法官来了，要求保护数百万美国人的健康保险——以及保护我们所有人免受保险公司歧视。是时候让法庭系统的其他部分做好自己的工作，结束对一项仍在造福数百万美国人的法律的轻率攻击了。
乔纳森·格鲁伯是麻省理工学院的福特经济学教授，他从1992年开始在该学院任教。他也是国家经济研究局卫生保健项目的主任和美国卫生经济学家协会的前主席。他经常被称为《平价医疗法案》的主要设计师。他的书跳跃式启动美国,和合著者西蒙·约翰逊现在已经出版了。
THEY CALL ME AN ARCHITECT OF OBAMACARE. I CAN'T STAND BY AS ACTIVIST JUDGES THREATEN AMERICAN LIVES | OPINION
In 2014, the Affordable Care Act provided affordable health insurance to 20 million Americans. Equally important, it created the first non-discriminatory insurance market in the U.S., ensuring that Americans would no longer be one bad accident or one bad gene away from bankruptcy. A key piece of the law was the individual mandate, which was designed to incite broad participation in insurance markets and keep premiums down in state exchanges.
The law worked quite well. Not only did millions gain insurance, but tens of millions more slept better at night knowing that if they lost their insurance, they wouldn't be "uninsurable" because of prior illness. Premiums in state exchanges were 16 percent below projections in 2014, and they rose on average about 8.6 percent per year over the first three years of the program, well below the 10 percent or more per year before the ACA. Overall health care costs in the U.S. grew at their slowest rate in measured history.
But the mandate was unpopular. And in 2017, the Republican-led Congress effectively removed it by setting the associated tax penalty to zero. This had the expected effect of lowering enrollment in state exchanges and significantly raising premiums due to a less healthy risk pool. Yet the ACA, while weaker, soldiered on, with more than 17 million individuals currently owing their coverage to the law and other provisions, such as non-discrimination, remaining in place.
Now, the ACA itself is at risk. In a highly controversial decision, a district court in Texas ruled in December 2018 that since the individual mandate was no longer valid, the entire ACA had to be repealed. The judge, Reed O'Connor of the Northern District of Texas, is well-known as a conservative opponent of government, and legal experts on both sides of the aisle have pointed out that there is no basis for his decision.
O'Connor argued, based solely on his own logic, that the mandate is not "severable" from the ACA—that without a mandate, the law is no longer valid. This reasoning flies in the face of the facts: The mandate is clearly severable from the general ACA, as demonstrated by the fact that the ACA still functions well after the mandate's effective removal. The judge's argument also directly contradicts congressional intent. Congress had a shot to kill the whole ACA, and it did not—instead simply cutting out the mandate. That is, Congress itself has clearly shown that the mandate is viewed as separable from the larger law.
Nevertheless, this week, an appellate court didn't reject the judge's improper reasoning. The court simply sent it back to him to take another shot at it. The judges of the Court of Appeals for the Fifth Circuit even spiced up their report with a random footnote so politicized, it could be a direct quote from our president: "Some opponents of the ACA assert that the goal was not to lower health insurance costs, but that the entire law was enacted as part of a fraud on the American people."
This is a complete abdication of responsibility in the face of an improper decision. Rather than make the hard call, the appellate judges punted—conveniently, until almost certainly after the 2020 election.
The implications for Americans are dire. Recent research shows that thousands of lives have been saved by the expansion of insurance coverage under the ACA. And U.S. citizens by large margins support the removal of discrimination from insurance markets. Indeed, the parts of the ACA that remain—including making coverage affordable through both the public Medicaid program and tax credits to private insurance—are widely popular.
Holding photographs of Americans with pre-existing medical conditions, Democratic members of Congress attend a press conference on the steps of the U.S. Capitol on July 9 in Washington, D.C.
Moreover, there is no simple alternative to the ACA. Congressional Republicans and the Trump administration have sold us a fiction of "repeal and replace," but about 10 years after the debate over the ACA, there is no replace. The only serious efforts in Congress to address the ACA would have left between 20 million and 32 million people without insurance—and would have reintroduced the ability of insurance companies to discriminate against our sickest neighbors, friends and family members. Meanwhile, efforts on the left to replace the ACA with something much bolder, such as single-payer health care, have been unsuccessful for decades and don't have widespread public support once the costs of these plans are understood.
The irony here is quite rich. Remember, opponents of the ACA often warned that it would "take away your insurance." (In fact, most individuals who "lost" insurance under the ACA were those whose coverage, largely unbeknownst to them, left them exposed to unaffordable medical bills.) Now, the removal of the ACA would result in many more Americans losing access to real, meaningful insurance.
The decade of fighting over the ACA shows how legislating is supposed to work, for better or worse. When one party had control of the Congress and the White House, it passed a law. When another party took over, it attempted to repeal that law. Finding itself unable to, it removed a part of the law it didn't like. That should have been the end of the story.
But now a rogue judge in Texas is coming for the health insurance coverage that protects millions of Americans—and the protections against insurance company discrimination that benefit all of us. It's time for the rest of the court system to do its job and end this frivolous attack on a law that still works to benefit millions of Americans.
Jonathan Gruber is the Ford Professor of Economics at the Massachusetts Institute of Technology, where he has taught since 1992. He is also the Director of the Health Care program at the National Bureau of Economic Research and former President of the American Society of Health Economists. He is often referred to as a key architect of the Affordable Care Act. His book Jump-Starting America, with co-author Simon Johnson, is out now.
