5 Ways Nixing The Affordable Care Act Could Upend U.S. Health System

Philadelphia demonstrators protested earlier moves by Republicans to repeal the Affordable Care Act last February. If the ACA is indeed axed as unconstitutional, health policy analysts say, millions of people could lose health coverage, and many aspects of Medicare and Medicaid would change dramaticall

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If last Friday’s district court ruling that the Affordable Care Act is unconstitutional were to be upheld, far more than the law’s most high-profile provisions would be at stake.

In fact, canceling the law in full — as Judge Reed O’Connor in Fort Worth, Texas, ordered in his 55-page decision — could thrust the entire health care system into chaos.

“To erase a law that is so interwoven into the health care system blows up every part of it,” says Sara Rosenbaum, a health law professor at the George Washington University School of Public Health. “In law they have names for these — they are called superstatutes,” she says. “And [the ACA] is a superstatute. It has changed everything about how we get health care.” (That concept was developed by Abbe Gluck, a professor at Yale Law School.)