The Association for Community Affiliated Plans (ACAP) is a national trade association which represents not-for-profit Safety Net Health Plans. Collectively, ACAP plans serve more than twenty million enrollees, representing nearly half of all individuals enrolled in Medicaid managed care plans.

Our mission is to strengthen not-for-profit Safety Net Health Plans in their work to improve the health of lower-income and vulnerable populations. Our vision is to improve the health and well-being of lower-income and vulnerable populations and the communities in which they live.

Through the Medicaid is US campaign, ACAP has strengthened its advocacy as a voice for Medicaid.


ACAP has joined the Alliance of Community Health Plans (ACHP) to file a joint amicus curiae brief in support of the Affordable Care Act in the case of Texas vs. United States. The case is currently pending with the United States Court of Appeals for the Fifth Circuit, after a federal district judge in Texas ruled that the Affordable Care Act was unconstitutional. 

Click Here to Read the Full Amicus Curiae Brief

The Affordable Care Act has had a transformative effect on millions of people covered by ACHP and ACAP members, enabling them to access health care, manage pre-existing and chronic conditions, and lead better, more engaged lives. The ACA’s expanded access to affordable healthcare with meaningful benefits furthered the core mission of not-for-profit community health plans to transform healthcare in their communities by reducing costs, improving health outcomes, and delivering high quality care. Absent the ACA, millions will lose health insurance coverage and access to health care, crippling ACHP and ACAP member plans’ abilities to fulfill their commitments to their communities. 


Upholding the district court ruling would imperil coverage for an estimated 20 million people by cutting off Marketplaces and rolling back Medicaid expansion. It would also have repercussions that the Administration has likely not contemplated, ranging from reopening the ‘donut hole’ in Part D plans to eliminating authority for Section 1332 waivers.

A full ACA repeal will allow insurers to discriminate on the basis of pre-existing conditions, reinstate lifetime limits on coverage, and exclude costly categories of coverage, such as prescription drugs or behavioral health. Not to mention the Federal budget deficit would go up by an estimated $350 billion over 10 years.

The Affordable Care Act is woven deeply into the fabric of how we deliver and pay for health care. It is part and parcel of the health care system in this country. Sustaining the trial court’s ruling will have a disastrous effects on millions of people’s ability to access and afford health care and may cripple the ability of ACHP and ACAP member plans to serve their communities’ needs for high-quality health care.

Based on oral arguments in the Fifth Circuit, it now appears likely that the fate of the Affordable Care Act will be decided by the Supreme Court of the United States -- the third such case in seven years. A final decision in Texas v. U.S. would likely be made in the summer of 2020, with consequences for millions of Americans in the middle of a presidential election. Now more than ever, it is vitally important to make our voices heard.


One great irony in this case is that the State of Texas is ignoring the impact this litigation would have on its own citizens in the Lone Star State. 

Community Health Choice is an ACAP member in Harris County, Texas. It was created by the Harris County Hospital District as a separate not-for-profit organization specifically to serve low-income, underserved residents of the Houston area by becoming licensed as a health maintenance organization and contracting with the State of Texas for its Medicaid Managed Care program. It has been serving low-income residents who qualify for Medicaid since 1997, and entered the federally-facilitated health insurance marketplace in 2014. Community offered seven plans in the Texas ACA marketplace in 2018.  

Community serves approximately 275,000 Medicaid or CHIP insurance recipients and roughly 110,000 people under its marketplace plans. Community estimates that more than 80,000 of its marketplace enrollees rely on the ACA’s advance premium tax credit and/or cost-sharing reductions to afford coverage. Because Community serves a low-income population, many of its members previously were uninsured, have pre-existing conditions, cannot afford large deductibles, and lacked access to health insurance and, by extension, much-needed medical care.  

The Texas vs. United States lawsuit puts this much-needed medical care at risk. 


As a voice for Medicaid, ACAP has continued to advocate for all Americans who are made healthier through the Affordable Care Act.  

Our advocacy was instrumental in protecting the ACA from hostile action in Congress. Now we are fighting to protect the ACA from hostile action in federal court. 

As a fellow advocate for Medicaid, please lend your voice to this effort. Please share our amicus brief so that others can learn about the threat this lawsuit poses to our healthcare system.