On Friday, December 14, 2018, U.S. District Judge Reed O’Connor ruled that the Patient Protection and Affordable Care Act (ACA) must be struck down.  Specifically, the court held that the individual mandate—which requires most Americans to have basic health insurance—is unconstitutional.  Supporters of the ACA have already expressed an intent to immediately appeal Judge O’Connor’s decision. The ruling did not immediately enjoin the continued functioning of the ACA and White House Press Secretary Sarah Sanders issued a statement shortly after the ruling stating that, “Pending the appeal process, the law remains in place.”  Likewise, CMS promptly added a notice to its website that reads, “Court’s decision does not affect this season’s open enrollment” and individuals were able to sign-up for coverage through the December 15 open enrollment deadline.  Though the ruling does not immediately affect the functioning of the ACA, it does create uncertainty for stakeholders such as insurers, healthcare providers, and patients with pre-existing conditions.  A more detailed review of the case, industry implications, the appeals process, and expected legislative responses can be found in a Client Alert by King & Spalding’s healthcare team, available here.