host: for the next hour, we talk about the affordable care act in light of a recent decision by a texas judge and guests joining us, benedic ippolito serves as the economic studies fellow at the research institute workedly, who previously in the obama administration. thank you for joining us.

emily, could you briefly recount what the texas judge said about the affordable care act in your thinking on the judgment? aca wasast friday, ruled unconstitutional because in 2017, congress passed a tax bill that included a provision that the aca individual mandate would be reduced to zero. this essentially took the heart out of the mandate. legislation was passed other than that in the tax bill. because of this thing that congressman pointed, the judge decided that renders the aca unconstitutional. this is a judgment in a case brought by the plaintiff that numerous scholars on the right and left have called absurd. context, go back to

early days. 2008, 2010, aca debates. the three legged stool. pillars,ad the three the mandate, without the pillars, the stool falls over. that is the concept behind the case. as emily says, i do not know i have heard anyone showing support for the judge's ruling. that includes a number of voracious aca critics. it is unusual to be discussing aca lawsuit and have everyone be in agreement. host: part of the language says congress stated unequivocally that the individual mandate is essential for the aca and that the text makes clear the mandate must work with other provisions. does that one element make

sense? guest: there are separate issues. the good policy issue. the legal issue. good policy issue is -- if you're going to structure insurance in the way the aca did, you have to do something to get people to want to buy insurance, whether incentive or mandate, that is separate. for the policy side, if you want it to work, you need people to go into the market, other than those who want to spend money. on the legal side, it is congressional intent. did congress intend the individual mandate, the aca to exist without the individual mandate/ the judge is saying no. if you look at the quotes, look congress said they could not be severed from the bill. what is odd is that congress literally just severed the individual mandate from the bill.

inferring congressional intent through this murky lens of history seems overkill when we can point to last year, when congress eliminated the mandate. host: expand on that and the role of the supreme court. guest: absolutely agree. what is good policy is different from what is legal. if you look at aca repeal debate 2017, congress had intent of revealing major prohibition of aca including mandate, but keeping others. if you talk to members of congress, even republican members, i doubt anyone had the idea that when they passed the tax bill, they were doing it to get rid of the entire aca. despite the ruling on friday, the most important thing for people to know is even though the aca was ruled unconscious usual, the law is still in

effect. it is the law of the land. if you have coverage, it is still in effect. the next step for the lawsuit is that it will go to appeal to a higher court and ultimately to the supreme court perhaps. based on all the other legal scholarship out there, everyone aside from the plaintiff and the judge think this is a poor argument the plaintiffs are making and ultimately the courts would decide for the aca. guest: to build on that. it does not help that current members of congress are saying, that is not why i voted for the tax cuts, to repeal the aca. the idea that we are inferring congressional intent doesn't really seem to be on strong footing. that is where the case is shaky. guest: what members of congress themselves have said about intent. host: we are talking with our

guests. we have divided the lines differently. enrolled in the aca? (202)-748-8000. all others, (202)-748-8001. what is the worst case scenario going forward? lawsuit, this injects uncertainty into the aca individual market. is it still law? so on. having said that, it is important to think about the timing. argued, it sounded like the judge would issue a quick decision. that was not the case. midterm elections came, no decision, argued, it sounded like the open enrollment, no decision. the decision only came at the end of open enrollment for the majority of states. for most states, it is unlikely to have any effects. i will be looking at the seven states that still have open enrollment going on. we learned last year, as the

trump administration, sabotaged what was going on, we had individual strong numbers for enrollment. we might have the old adage proved true, any publicity is good publicity. guest: the fact that the ruling coincided with the last night of open enrollment, traditionally a night of heavy activity on oath , this- health care.gov was really a political decision, and not one that is grounded in legality. host: when it comes to this, you talked about the numbers, centers for medicaid and medicare, 2018. 11.8 million enrolled. 27% are new customers. most chose silver plans. the average premium before tax credit, $621.

what do the numbers tell you? guest: one of the important things those numbers show is even though the number should be higher, we might see modest growth in the exchanges, that would be happening if not for the trump administration's dialing back, outreach, willy-nilly policy decisions. the overall robustness of the numbers shows the subsidies and regulations, the reforms that allow people to get coverage with pre-existing conditions or at a fair price even though they are elderly. that is holding up the market. it is not the mandate. the mandate is helpful to get people enrolled, whether in the exchange or medicaid or private insurance in other forms and -- without the mandate, the aca is

still standing. host: it is the sustainability of subsidies that are causing concern. anyonei don't know that would look at the current state of the exchange and say, we nailed it. what emily describes, is the case. there is a core group of heavily subsidized enrollees that are insensitive to year-over-year price changes. that is how they are designed. we can quibble. will befact that they there with or without a mandate and policy changes. the challenge to the aca moving forward for enrollment is, how do you enroll people not getting heavy subsidies? the plans are expensive for what you are getting if you don't have a subsidy. thinking about how you get those people to sign up is a challenge. as you say, the sustainability issue. the subsidies work, as the price goes up, you have to spend a

certain portion of your income. the government absorbs the price increases beyond that. at a point, that becomes problematic. we cannot spend every dollar we have on health care. there is a limit at which subsidies would run out hypothetically. we can't spend more than half a percent of gdp or something. whether someone would actually enforce that is a separate question. having a market where the only subsidized and that keeps increasing year-over-year, is a tenuous situation. trying to move away from that to something where we can get regular consumers to want to buy the products would be an improvement for the individual market. host: this is ryan in california, he is enrolled in aca. good morning. caller: good morning, pedro. the idea that you are having a debate is a joke. they are both for the aca. let's not forget, the aca was

called the affordable care act. it is far from affordable. it is not affordable for taxpayers or the people who have it. rand paul, get him on when you talk to some sort of person for the aca, he knows the regulations in order to get back to $30 a month health care. host: you are currently enrolled. what is your experience? caller: it is a joke. it is so expensive, you cannot afford it. premiums are out of control. the taxpayer is flipping the bill. washington journal needs to stop putting on this charade. this is not a debate. these people are for the aca. everyone is against this guy who stood up to the aca and said it is unconstitutional. it is a farce. host: you made your point. a lot of people talk about the cost. guest: we are both for people

having health coverage and being able to afford seeing a doctor when they need to or being able to go to the hospital without being financially ruined. the aca has done a lot in the individual markets. if you have a health history, like asthma or a hip replacement, you could not even get any coverage. away could turn you entirely. aca has made huge strides for getting people covered. 20 million more people have coverage. there is more that can be done. a lot of families are underinsured. they cannot afford cost-sharing or the deductibles are too high. there is more that democrats have proposed in order to lower costs. people on theut higher range of income, not being able to afford coverage.

think about other ways we can extend subsidies to make sure insurance is affordable for people, middle-class. guest: thinking about the sustainability, brian is right that cost is an issue. --

chairman powell: over the past year, the economy has been growing at a strong pace. the unemployment rate has been near record lows and inflation has been low and stable. all of those things remain true today. since the september meeting, some cross current have emerged. i'll explain how my colleagues are incorporating about the