Representative Nancy Pelosicalled the ruling “absurd,” adding that Democrats in the House will“swiftly intervene in the appeals process” once they take controlin January.

Obamacare was struck down by a Texas federal judge in a ruling that castsuncertainty on insurance coverage for millions of U.S.residents, drawing sharp condemnation from some medicalprofessionals and a vow for action by top Democrats.

President Donald Trump termed the ruling “a big big victory by ahighly respected judge” and an alternative path to the long-timeRepublican goal of repeal-and-replace.

“We'll be able to get great health care,” Trump said Saturdayduring an unannounced visit to Arlington National Cemetery, where a“Wreaths Across America” holiday wreath-laying event was under way.“We'll have to sit down with the Democrats to do it, but I'm surethey want to do it also.”

Related: Democrats now have the power to protect theACA

The decision Friday finding the Affordable Care Actunconstitutional comes at the tail end of a six-week openenrollment period for the program in 2019 and underscores a dividebetween Republicans who have long sought to invalidate the law andDemocrats who fought to keep it in place.

The White House said the ruling will be put on hold during anappeals process that's destined to go all the way to the U.S.Supreme Court, drawing confirmation from Democrats vowing a rapidappeal. It has “no impact to current coverage or coverage in a 2019plan,” Seema Verma, administrator for the Centers for Medicare andMedicaid Services, said on Twitter.

U.S. District Judge Reed O'Connor in Fort Worth agreed with acoalition of Republican states led by Texas that the AffordableCare Act, the signature health-care overhaul by President BarackObama, needed to be eviscerated after Congress last year zeroed outa key provision — the tax penalty for not complying with therequirement to buy insurance.

'133 million'

“Today's ruling is an assault on 133 million Americans withpre-existing conditions, on the 20 million Americans who rely onthe ACA's consumer protections for health care, and on America'sfaithful progress toward affordable health care for all Americans,”California Attorney General Xavier Becerra said in a statement. Aspokeswoman for Becerra vowed a quick challenge to O'Connor'sruling. O'Connor was appointed to the federal bench by PresidentGeorge W. Bush.

Representative Nancy Pelosi, who's likely to become Speaker inthe new Congress, called the ruling “absurd,” adding that Democratsin the House will “swiftly intervene in the appeals process” oncethey take control in January.

Tonight's absurd ruling exposesthe monstrous endgame of the GOP's all-out assault on people w/pre-existing conditions & the ACA. When @HouseDemocrats takethe gavel, the House will swiftly intervene in the appeals processto #ProtectOurCare! — Nancy Pelosi (@NancyPelosi) December15, 2018

Senator Chuck Schumer, the top Democrat in the Senate,castigated Republicans for “pretending to support people withpre-existing conditions while quietly trying to remove that supportin the courts.” He tweeted that Democrats “will force votes toexpose their lies.” Senator Joe Manchin, a West Virginia Democratwho won re-election in November on a pro-Obamacare platform, calledthe ruling “misguided and inhumane.”

Democrats weren't the only ones to criticize the decision.Arthur Evans, chief executive officer of the American PsychologicalAssociation, said his group was “very concerned for the millions ofAmericans” who get insurance through the health law.

“As our nation is in the midst of an opioid crisis, thiscoverage is especially needed,” Evans said in a statement. “Weshould be expanding access to health insurance, includingbehavioral health services, rather than stripping coverage fromAmericans in need.”

Texas and an alliance of 19 states argued to the judge thatthey've been harmed by an increase in the number of people onstate-supported insurance rolls. They claimed that when Congresslast year repealed the tax penalty for the so-called individualmandate, it eliminated the U.S. Supreme Court's rationale forfinding the ACA constitutional in 2012.

The Texas judge agreed. He likened the debate over whichprovisions of the law should stand or fail to “watching a slow gameof Jenga, each party poking at a different provision to see if theACA falls.” He also wrote that it's clear the individual mandate isthe linchpin of the law “without marching through every nook andcranny of the ACA's 900-plus pages.”

“The court must find the individual mandate inseverable from theACA,” he said. “To find otherwise would be to introduce an entirelynew regulatory scheme never intended by Congress or signed by thepresident.”

While Trump and Texas Attorney General Ken Paxton were quick topraise the ruling, while the American Medical Association calledthe decision “an unfortunate step backward for our healthsystem.”

As I predicted all along,Obamacare has been struck down as an UNCONSTITUTIONAL disaster! NowCongress must pass a STRONG law that provides GREAT healthcare andprotects pre-existing conditions. Mitch and Nancy, get itdone! — Donald J. Trump (@realDonaldTrump) December 15,2018

Some health-care law experts were quick to critique the judge'sreasoning and predicted the ruling will be overturned.

“We know what Congress' intent was in 2017 — that was to pullthe individual mandate while keeping the rest of ACA intact,”University of Michigan law professor Nicholas Bagley said. “Now wehave a judge saying we have an unenforceable mandate. This wholething is bonkers.”

With just one day left in the sign-up period for 2019 Obamacarecoverage, the judge's ruling is unlikely to have much of an effecton those actively shopping for insurance for next year. As of Dec.8, 4.1 million people had chosen plans through thefederal-government run portal that 39 states use forenrollment.

Total enrollment is on track to be lower than in previous years,which many critics have credited to efforts by the Trumpadministration to promote alternatives to the law or cut back onits promotion.

Centene Corp. of St. Louis and California's Molina Health Inc.are the insurers that would be hurt the most if Friday's rulingstands, Ana Gupte, health care analyst at Leerink Partners, wrotein an analysis late Friday.

California and Democratic officials in 14 states, along with theDistrict of Columbia, won permission to defend the ACA in the FortWorth case when the Trump administration sided with the statesseeking to dismantle it. They contended that overturning the lawwould throw millions off health insurance rolls by reversingMedicaid expansion, ending tax credits that help people andempowering insurers to once again deny coverage based onpre-existing conditions.

Justice Department lawyers urged the judge to strike down theindividual mandate and provisions requiring insurance companies tocover individuals with preexisting health conditions and chargethem the same premiums as healthy individuals. They argued thejudge should spare the rest of the law, which includes Medicaidexpansion, the employer mandate, health exchanges, premiumsubsidies and federal health-care reimbursement rates forhospitals.

The judge's ruling would, since it overturns the entire act,also end provisions that have little to do with health insurance.Those include parts of the law on adding calorie counts onrestaurant menus and speeding to market cheaper versions of costlybiotechnology drugs.

Maryland Attorney General Brian Frosh launched a counterattackSept. 13 to save Obamacare, seeking a judgment that the AffordableCare Act is constitutional and a court order barring the U.S. fromtaking any action inconsistent with that conclusion. Frosh suedthen-U.S. Attorney General Jeff Sessions and the federaldepartments of Justice and Health and Human Services.

The Texas case is Texas v. U.S., 4:18-cv-00167-O, U.S. DistrictCourt, Northern District of Texas (Fort Worth). Frosh's case isState of Maryland v. United States, 1:18-cv-02849, U.S. DistrictCourt, District of Maryland (Baltimore).

— With assistance by Anna Edney, Toluse Olorunnipa,Christopher Flavelle, Ariella Phillips, and Sara Hansard

Read more: 

• The dismantling of the ACA: Atimeline
• Hospitals, insurers sink as ACA ruling joltsinvestors
• Fewer people enrolling in Obamacare as alternativeshave increased

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