On Thursday, the Supreme Court rejected yet another major challenge to the Affordable Care Act, allowing the 2010 law to stand despite Republican objections that it was unconstitutional.
Though the court’s decision did not address the merits of the legal issues raised by the states, Democrats hailed it as the latest sign of the controversial law’s permanence, which was a centerpiece of former President Barack Obama’s policy agenda. Republicans in Congress, the White House, and several states have long sought to weaken or repeal the law’s provisions.
Texas, along with 17 other states, went on to tell the court that the rest of Obamacare had to be repealed as well because its other provisions – such as protections for people with preexisting conditions and the prohibition on lifetime benefit caps – were based on the requirement that all Americans obtain some form of health coverage.
However, the nation’s highest court never addressed these issues in its decision on Thursday. Instead, it ruled that the states that brought the suit lacked the legal authority to do so. The states sued because they claimed they would have to pay a portion of the cost for new Medicaid and similar program enrollees. However, the court determined that by eliminating the penalty, the states could no longer reasonably claim that they would have to pay more.
Despite recent attention on the Supreme Court’s shift to the right, the opinion included both conservative and liberal justices – and a larger majority than in previous Obamacare cases. Chief Justice John Roberts and Associate Justices Clarence Thomas, Sonia Sotomayor, Elena Kagan, Brett Kavanaugh, and Amy Coney Barrett joined Breyer. Associate Justices Samuel Alito and Neil Gorsuch joined in the dissent.
After Trump’s Justice Department refused to defend the law, California and other blue states stepped in. They contended that the zeroed-out penalty at the heart of the case couldn’t be unconstitutional because it didn’t necessitate any action on the part of the defendant. And, they added, if it was so fundamental to the rest of the health-care law, Congress would have repealed the entire thing rather than just one part of it.
The landmark Affordable Care Act, which was hotly debated early in Obama’s presidency, established health-care marketplaces through which nearly 12 million Americans who do not have insurance through their job or a government program purchased coverage last year. It also provided incentives for 36 states to expand their Medicaid programs.
Obamacare also imposed new regulations on other sectors of the industry, which accounts for nearly one-fifth of the US economy. It, for example, prohibited insurance companies from denying coverage to people with preexisting conditions such as cancer or diabetes, which had previously left ill Americans without insurance.
Lawmakers were concerned at the time that the policy would encourage people to forego coverage until they became ill: Why pay for a health insurance policy if insurance companies are required to provide coverage after a patient becomes ill? The solution: the so-called individual mandate, which requires most Americans to have health insurance or pay a penalty.
Conservatives objected to the idea of the government forcing people to buy something, and the individual mandate quickly became one of the law’s most contentious provisions. Trump has repeatedly attempted to undermine the individual mandate, first by signaling that his administration would not enforce it, and then by supporting the 2017 law that technically kept the penalty in place but reduced the amount to $0.
In December 2018, federal District Judge Reed O’Connor ruled that because the Supreme Court initially upheld the individual mandate under Congress’ taxing power, it could not be sustained with a zeroed-out penalty. His decision, which was stayed while it was appealed, threatened to demolish the entire health-care law.
The individual mandate is unconstitutional, according to a panel of the United States Court of Appeals for the Fifth Circuit in New Orleans, “because it can no longer be read as a tax.” Rather than overturning the entire law, as O’Connor would have done, the panel remanded the case to the district court for further analysis to determine which parts of the law could be separated from the individual mandate.