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Affordable Care Act Survives Its Toughest Challenge Before the High Court

June 17, 2021 by Dan McCue
The Supreme Court building as seen from the grounds of the U.S. Capitol. (Photo by Dan McCue)

The Supreme Court on Thursday dismissed a challenge to the Affordable Care Act, preserving insurance coverage for millions of Americans.

By a 7-2 vote, the justices left the entire law intact and ruled that Texas and other Republican-led states (as well as two individual plaintiffs) have no right to bring their challenge to the Obama-era law to federal court.

The law’s major provisions include protections for people with pre-existing health conditions, a range of no-cost preventive services and the expansion of the Medicaid program that insures lower-income people, including those who work in jobs that don’t pay much or provide health insurance. 

Also left in place was the law’s early requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero.

The elimination of the penalty was central to GOP assault on the law. The central argument of lawmakers in Texas and other Republican-led states was that without the mandate, the rest of the law should fall, too.

Their hope was that with a Supreme Court tilting to the right after former President Donald Trump appointed three of its current members, the court would declare the law unconstitutional.

But the third major attack on the law at the Supreme Court ended the way the first two did, with a majority of the court rebuffing efforts to gut the law or get rid of it altogether. 

Trump’s three appointees to the Supreme Court — Justices Amy Coney Barrett, Neil Gorsuch and Brett Kavanaugh — split their votes. Kavanaugh and Barrett joined the majority. Gorsuch was in dissent, signing on to an opinion from Justice Samuel Alito.

Justice Stephen Breyer wrote for the court that the states and people who filed a federal lawsuit “have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.”

In dissent, Alito wrote, “Today’s decision is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue.” 

Reaction to the ruling was swift.

“Once again, the Supreme Court has upheld the constitutionality of the Affordable Care Act and the transformational protections it provides every American, no matter where they get their coverage,” House Speaker Nancy Pelosi said in a written statement.

“Today’s Supreme Court ruling is a landmark victory for Democrats’ work to defend protections for people with pre-existing conditions against Republicans’ relentless efforts to dismantle them,” she continued. “On day one of our House Majority, Democrats acted decisively to throw the full legal weight of the House of Representatives into the fight against this GOP lawsuit.  We will never forget how Republican leaders embraced this monstrous suit to rip away millions of Americans’ health care in the middle of a deadly pandemic.”

Sen. Edward J. Markey, D-Mass., said the high court’s decision “ensures that nearly three million Massachusetts residents with pre-existing conditions can breathe easier knowing that far-right attacks on their health care have fallen short again. 

“The Affordable Care Act is a lifesaving law for millions of Americans, and we will do everything we can to protect that care as we fight to expand it to universal coverage. Now that the Supreme Court has set aside yet another challenge to the Affordable Care Act, the GOP should end its failed and unpopular crusade to rob millions of Americans of their health care,” Markey said.

Support for the Supreme Court’s decision also came from the National Education Association — the nation’s largest union representing more than 3 million educators, health care workers and public employees.

The NEA had signed onto an amicus brief urging the court to uphold the health care law.

“No matter our race, background, sex or ZIP code, everyone deserves access to affordable and high-quality health insurance,” said NEA President Becky Pringle. “That’s why Congress passed the Affordable Care Act, and the Supreme Court has repeatedly upheld the constitutionality of the health care law as challenge after challenge has come before the court over the past decade. If there have been any lessons learned from the COVID-19 pandemic, it is that access to universal, quality and affordable health care is a matter of economic and national security. Today’s decision by the court sends yet another clear message that there is no appetite — legal or otherwise — to dismantle health insurance on which more than 21 million Americans depend.”

The Biden administration has been working to expand access to health care, with President Joe BIden declaring the law is key to achieving health care coverage for all.

His sweeping COVID-19 relief bill significantly increased subsidies for private health plans offered through the ACA’s insurance markets, while also dangling higher federal payments before the dozen states that have declined the law’s Medicaid expansion. 

About 1 million people have signed up with HealthCare.gov since Biden reopened enrollment amid high levels of COVID-19 cases earlier this year.

The administration says an estimated 31 million people are covered because of the law, most through its combination of Medicaid expansion and marketplace plans. But its most popular benefit is protection for people with pre-existing medical conditions. 

They cannot be turned down for coverage due to pre-existing conditions, or charged a higher premium. While those covered under employer plans already had such protections, the Affordable Care Act guaranteed them for people buying individual policies.

Sen. Patty Murray, D-Wash., chair of the Senate Health, Education, Labor, and Pensions Committee, called the Supreme Court’s ruling “cause for celebration,” but also warned that it should be seen as “a call to further action, not an excuse for complacency.” 

“While I hope this victory for families is the final chapter in Republicans’ long, damaging campaign to undermine the health care hundreds of millions of people rely on, I know our work to help patients is far from over,” she said. “The COVID-19 pandemic has made painfully clear we have more to do to ensure every person in this country can get quality, affordable health care. That’s why I am working with Congressman Pallone to gather input and craft comprehensive legislation establishing a federal public option for health coverage.

“With this existential threat to the health coverage and protections so many people rely on finally put to rest, and a president who actually believes health care should be a right not a privilege finally back in the White House—we must seize this opportunity to build on past progress in health care with bold solutions,” Murray said. “We need to bring down costs for patients and move toward universal coverage, and I plan to work with President Biden and my colleagues on bold steps to do just that—like empowering Medicare to negotiate lower drug prices, expanding eligibility for Medicare to more people, making the premium tax credit increases in the American Rescue Plan permanent, and establishing a public option to allow all families to get quality, affordable coverage.”

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