The Supreme Court has rejected the latest constitutional challenge to the Affordable Care Act, which means that 31 million Americans won’t lose their health insurance and protections for people with preexisting conditions won’t go away.
Yes, Obamacare has survived again.
This time, the threat was a lawsuit that 20 state Republican officials originally filed in 2018 and that the Trump administration officially supported in court, even though the federal government almost always defends statutes in such litigation.
The ruling was 7-2, with Justice Stephen Breyer writing the opinion. The court rejected the lawsuit based on “standing,” meaning the plaintiffs could not show an injury that required a ruling on the merits.
At the heart of the GOP lawsuit was an argument that former President Donald Trump and the Republican Congress had inadvertently created a fatal constitutional flaw in the law when, in 2017, they reduced the penalty for not carrying insurance, known as the “individual mandate,” to zero.
Because they had changed the dollar value of the mandate but not its authorizing language, and because a previous Supreme Court ruling had upheld the mandate only as a tax, the GOP lawsuit claimed that the provision had lost its justification on the theory that a penalty of zero dollars can’t really be a tax.
As a result, the lawsuit said, the entire law had to come off the books. Had the Supreme Court agreed, it would have wreaked havoc on the health care system, which has adapted itself to the law’s far-reaching rules and funding arrangements.
A Nonsensical Case And A Surprise Ruling
It was a nonsensical case from the beginning, as even conservative scholars acknowledged. Among those urging the justices to reject the lawsuit, which came to be known as California v. Texas, were several lawyers who had been architects of previous challenges.
Still, the lawsuit won favorable rulings in two lower courts, each time with Republican-appointed judges issuing the decision.
And although the Affordable Care Act survived two previous existential challenges at the Supreme Court, one of them was a narrow, 5-4 decision with Ruth Bader Ginsburg supplying one of the majority votes.
Trump appointee Amy Coney Barrett has since replaced Ginsburg, who died last fall, taking her seat just in time for oral arguments in November.
Barrett didn’t say much during the case that day. But several of her conservative colleagues did, expressing open skepticism of the lawsuit’s core arguments.
That turned out to be a harbinger of the final outcome, although the contours of the final ruling were different from what many observers of the court and the hearing had expected.
Instead of a ruling on the constitutionality of the mandate or the necessity of striking down the whole law, rather than parts, the justices limited themselves to the standing question. Since the mandate penalty is now zero, the justices ruled, nobody is suffering an injury that requires the court to act.
“We proceed no further than standing,” Breyer wrote in the opinion. “The individuals have not shown that any kind of Government action or conduct has caused or will cause the injury.”
Although standing hadn’t gotten a lot of attention in the political discussion, it had drawn some sharp questions during oral arguments ― and is a key issue of law.
“The Court held that the plaintiff states failed to satisfy one of the most fundamental requirements for suing in federal court — claiming a real injury,” said Joseph Palmore, who as co-chair of the appellate group at Morrison & Foerster coordinated one of the amicus briefs in defense of the law.
The 7-2 majority included Elena Kagan and Sonia Sotomayor, the two other justices appointed by Democrats, and four Republican appointees: John Roberts, the chief, plus Barrett, Brett Kavauagh and Clarence Thomas. (Thomas wrote a concurring opinion.)
The only dissents came from GOP appointees Samuel Alito and Neil Gorsuch.
With Trump instructing the Justice Department to support the GOP lawsuit, defense of the Affordable Care Act fell to Democratic state officials led by Xavier Becerra, who at the time was attorney general for California.
On Thursday, Becerra, who is now the U.S. Secretary for Health and Human Services, said: “Today’s ruling is a victory for all Americans, especially people with a pre-existing condition or anyone who was worried they could be forced to choose between their health and making ends meet. Health care should be a right ― not a privilege ― just for the healthy and wealthy.”
The GOP’s Losing War On Obamacare
The case was the third major lawsuit challenging the Affordable Care Act to reach the high court. And the 7-2 ruling was the most lopsided yet, even though the court has one more conservative justices than in the past, which is a sign of just how weak the merits of the case were.
It’s also, perhaps, a signal that the GOP’s war on Obamacare is running out of gas.
The program now enjoys majority support in the polls. Republicans running for office have largely stopped talking about repeal, perhaps because their failed attempt to wipe out the law in 2017 provoked a severe political backlash that helped Democrats regain control of the House of Representatives.
The lawsuit and the threat it posed allowed Democrats to make the Affordable Care Act an issue in the 2020 elections as well. Although it’s unclear how big a role it played in Trump’s loss, it was an important issue in many other races, including the two Senate elections in Georgia that ultimately gave Democrats control of that chamber.
“After more than a decade of challenges — when seemingly every stray comma has been litigated — the Affordable Care Act finally feels secure,” Nancy-Ann DeParle, director of the White House Office of Health Reform during the Obama administration, told HuffPost. “Once again, the Supreme Court has declared it the law of the land, and all Americans can rely on it as the foundation of our right to affordable, accessible, health care.”
More people are getting coverage through the Affordable Care Act than ever before, which is testimony to how much the law has accomplished. Research has demonstrated that the law has reduced financial hardship, increased access to medical care and improved health outcomes.
At the same time, many millions of people still lack insurance. And many millions with coverage struggle to pay premiums or out-of-pocket costs — or both.
That is one reason that President Joe Biden and his allies in Congress have talked about more government action to help people pay for their medical care, such as by providing government-run coverage or subsidizing the purchase of private plans ― or by taking other actions that would actually lower the cost of health care, including prescription drugs.
But all of these efforts would entail policy trade-offs and require big political fights, just like the Affordable Care Act did. And as the many years of federal litigation show, those fights can go on for a very long time.