This week, the U.S. Supreme Court heard oral arguments in California v. Texas, a case that could determine the fate of the Affordable Care Act, the landmark legislation signed into law by President Barack Obama in 2010.

ACA remains a big deal for Ohio and the nation.

California v. Texas is a product of an attempt by eighteen attorneys general to unravel the Affordable Care Act from one of its well-known cores: the so-called “individual mandate.” Though as Attorney General, Mike DeWine did not join his Republican counterparts, a decision that current Attorney General Dave Yost has reaffirmed, it is also true that neither has spoken out about the case.

But here’s where things start to go off the rails. The fifth circuit held that the individual mandate is, in a sense, the lynch pin of the whole ACA, and that without it, the whole bill – a more than 900-page piece of legislation with all sorts of important provisions – must also be struck down. 

The technical issue at hand is that of “severability,” namely whether the rest of the ACA can or cannot stand without the individual mandate. It’s a textbook case of using a chain saw where a paring knife would have done the job.

According to the Centers for Medicare and Medicaid, about 200,000 Ohioans currently receive their private health insurance through the ACA’s federally subsidized marketplace.

The fifth circuit found that the entire ACA must fall. But Ohioans need to know that the ACA is much more than a mandate to purchase subsidized health insurance. 

Most dramatically, were the Supreme Court to agree with the fifth circuit’s decision as it stands, Ohio’s Medicaid expansion could fall with the ACA. Currently, about 600,000 Ohioans access critical health care services through the Medicaid expansion.

The ACA also does much more than provide access points for health care services. The bill brought critical investments for health care research, including more than 40 projects totaling at least $92 million for research conducted in Ohio, the majority coming from the Patient Centered Outcomes Research Institute, which the ACA established. 

The ACA, a sweeping piece of landmark health care legislation, contains many provisions more than most people are aware. Though many experts believe that the Supreme Court is unlikely to simply follow the fifth circuit and strike down the entire ACA, it’s worth knowing some of the less-known items contained in the bill, to appreciate the vision of health care reform contained in it.

One does not need to be a constitutional scholar to recognize that none of these items have anything to do with the individual mandate. 

Nonetheless, we have good reason to worry about a sweeping Supreme Court decision that could strip about a million Ohioans of their access to critical health care services. The court’s decision is expected in June.

Mr. Skinner is associate professor of health policy at Ohio University’s College of Osteopathic Medicine.

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