One day after a U.S. Court of Appeals panel in New Orleans struck down a critical component of the Affordable Care Act, then returned it to seemingly hostile lower-court environs for another year of review, Minnesota advocates voiced frustration and alarm Thursday, Dec. 19, about the endangering of the legislation's most popular provisions.

On Wednesday, Dec. 18, the panel affirmed a lower court ruling that the individual mandate requiring Americans to obtain health insurance was no longer valid, citing the 2017 decision by Congress to remove its enforcement mechanism. But while the lower court had found this made the entire ACA invalid, the court of appeals asked for further reasoning.

"With this decision, millions of Minnesotans, including children and seniors, face the dangerous reality of losing coverage for pre-existing conditions, costly prescription drugs and necessary medical care," said Jeremy Drucker, state director for Protect Our Care Minnesota at a call-in press conference Thursday. "There is no backup plan, no assurances for the millions of Minnesotans who could be negatively impacted by this, or the chaos that will be unleashed on the healthcare system that is one-sixth of the nation's economy."

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"Let's be clear, this lawsuit does absolutely nothing to help people or support the common good," said Kenza Hadj-Moussa, public affairs director for TakeAction Minnesota at the same event. "Right now, Minnesotans are begging officials to take action on health care. Farmers and small business owners are desperate for a public option, rural communities need access to care, and all of us need lower prices. Instead of expanding health care or reigning in prices, Republicans have been working for years to repeal the ACA. "

State Rep. Hunter Cantrell, DFL-Savage, argued for new legislation to codify ACA-style health care protections in Minnesota.

"I will be offering legislation in February of 2020 to mandate that all health plans wishing to do business in Minnesota will cover patients with preexisting conditions," said Cantrell, 24, who credits a provision of the ACA for being covered by his parents' health plan when he was diagnosed with stage 2 Hodgkins Lymphoma at age 21. "Nobody in Minnesota should die from a treatable illness."

Others said state legislation cannot replace ACA funding.

"It's critically important to add these protections at the state level," said Protect Our Care's Drucker, "but I would just reiterate that there's no replacing the amount of funding that comes from the federal government if the ACA is repealed. . . . There's no simple replacing at the state level of the ACA."

"The ACA is 10 points more popular than the president," said Andy Slavitt in an interview with Forum News Service.

Slavitt, ACA chief with the Obama administration and current founder of the Minneapolis-based think tank US of Care, expressed skepticism about the argument that removing the individual mandate invalidated the ACA. "By law it can be separated, and in practice we just finished an open enrollment period without the individual mandate. . . . it's a much sturdier law than that."

"The law itself, its structure, is irrelevant," he continued. "What's relevant are the features of the law. If you ask people do they want to be protected against insurance companies discriminating against them if they have pre-existing conditions, they say yes. If you ask them do they want essential benefits guaranteed, the answer is yes. The elimination of lifetime caps is popular, Medicaid expansion is popular, filling the donut hole for seniors is exceedingly popular."

For Slavitt, prolonging its court challenges harms the economic welfare of Americans who take security in its stability.

"It's still the law of the land, but the longer this case is out there the more uncertainty it creates," he said. "If you are contemplating leaving your job and being a freelancer, and you have a kid with asthma, this does affect your life, because now you're not sure if two years from now, someone is going to say you don't have to be offered insurance that protects your kid's asthma.

"Healthcare is an underpinning which keeps people in a middle class life, with economic mobility. Any time you undermine those things, you're undermining people's ability to live the kind of life they want to live."