Mississippi Gov. Phil Bryant joined a lawsuit aimed at invalidating the Affordable Care Act, which more than 20 million Americans depend on for health insurance. Photo by Imani Khayyam

A three-judge panel in New Orleans wants a lower court to decide whether or not the entire Affordable Care Act, former President Barack Obama's signature achievement, should be struck down. The lawsuit, brought on behalf of Republican officials from across the country, including Mississippi Gov. Phil Bryant, could affect at least 20 million Americans, including about 90,000 Mississippians, who gained health insurance as part of the law.

On Wednesday, the 5th U.S. Circuit Court of Appeals ruled that the ACA's now-defunct "individual mandate," which requires most Americans to carry some form of health insurance, was unconstitutional. Congress repealed that part of the law in 2017, though.

The appeals court is asking U.S. District Court Judge Reed O'Connor in the Northern District of Texas to decide whether or not the rest of the law can stand without the individual mandate. When Congress passed the ACA in 2010, the mandate was seen as a key component of the law necessary to keep health-care costs low. Since its repeal, though, health-care costs have stabilized and, in some cases, dropped.

"It may still be that none of the ACA is severable from the individual mandate, even after this inquiry is concluded," Judge Jennifer Elrod writing in today's ruling, as reported by the Associated Press. "It may be that all of the ACA is severable from the individual mandate. It may also be that some of the ACA is severable from the individual mandate, and some is not."

If the law were struck down, it would end protections for people with pre-existing conditions against discrimination by health-insurance companies. Before the ACA became law, insurance companies could charge people with pre-existing conditions such as diabetes, cancer or heart disease more for coverage, or refuse to cover them outright.

In a dissent, Judge Carolyn Dineen King accused the other two judges on the panel of increasing "uncertainty over the future of the health care sector."

Last year, Gov. Bryant wrote that the lawsuit was not about pre-existing conditions—even though it ends protections—but about continuing "to uphold the Constitution," while Democratic critics of the lawsuit, like Democratic U.S. Rep. Bennie Thompson, "continue to gut it."

Under the ACA, Mississippi's uninsured rate dropped from 17.1 percent in 2013 to 12 percent in 2017. That still remains above the national average of 11.8 in 2017.

The 5th U.S. Circuit Court of Appeals oversees cases originating in Mississippi, Louisiana and Texas.

Ashton Pittman is the state reporter for the Jackson Free Press. Follow him on Twitter @ashtonpittman. Email him story tips to [email protected].