The architect of Obamacare warned the Affordable Care Act could die if the U.S. Supreme Court backs a ruling by a Texas judge calling the law unconstitutional — a decision that would force Massachusetts to strip coverage or pay astronomical bills. 

“It’s got very important financial implications for Massachusetts,” said Jonathan Gruber, an economist who has been described as the engineer of the law. “If the Affordable Care Act goes away, it means Massachusetts will have to bear all the costs of covering these people.”

The ruling by U.S. District Judge Reed O’Connor hands a victory to 20 Republican governors and state attorneys general who sued to wipe out the 2010 health care law, widely known as Obamacare. If the ACA is eliminated, Massachusetts’ requirements for insurance would be unchanged, but it would mean an end to federal contributions to states that have expanded Medicaid, as Massachusetts does.

Robert Greenwald, director of the Center for Health Law and Policy Innovation at Harvard Law School, said nothing will change immediately as a result of the decision by the Texas judge that found the law to be unconstitutional and invalid.

“This is certainly not the final word on the Affordable Care Act,” Greenwald said. “Obviously it’s going to be appealed, it’s going to be a long slog on this and other challenges to the ACA.”

O’Connor, a conservative judge appointed by President George W. Bush, had been widely expected to rule against the law, at least in part. His ruling, however, swept more broadly than many had expected, striking down the entirety of the health care law, including its provisions that have allowed California and 31 other states to expand Medicaid to 15 million Americans and the subsidies that keep insurance affordable for millions of others who do not get health care coverage through their employers.

The judge did not issue an injunction ordering the government to stop carrying out the law, however, meaning that its provisions will remain in effect pending further action.

The Trump administration had partially backed the suit by the conservative states, not endorsing their request to declare the entire law invalid. Instead, the administration had declined to defend the health care law and asked the judge to eliminate its guarantee of coverage for people with pre-existing health conditions.

A group of left-leaning states, led by California, that have stepped in to defend the health care law, quickly said they would appeal O’Connor’s ruling.

 

President Trump praised the judge’s ruling but health care groups denounced it. The American Medical Association said it would back an appeal, warning that the judge’s ruling would move the U.S. back toward the days when 20 percent of the population lacked insurance.

The states likely will appeal to the 5th U.S. Circuit Court of Appeals. Eventually, the case could wind up back at the Supreme Court, which has twice ruled in favor of the law.

Herald Wire Services contributed to this report.