The U.S. Supreme Court upheld the Affordable Care Act, rejecting a challenge by Republican-controlled states and former President Donald Trump’s administration to a landmark law that provides health insurance to 20 million people.
The 7-2
With health care accounting for a sixth of the U.S. economy, the stakes were massive. Advocates for patients, doctors, hospitals and insurance companies urged the court to uphold the law, warning of chaos should the measure be invalidated.
Opponents were trying to use a Republican-backed 2017 tax change to invalidate the entire law. The change eliminated a feature, the penalty for noncompliance with the individual mandate, that had been central in 2012 when the Supreme Court upheld the law as a legitimate use of Congress’ constitutional taxing power.
Writing for the court, Justice Stephen Breyer said the states and people who filed the latest suit — later backed by former President Donald Trump’s administration — lacked legal standing to go to court. Breyer said the people couldn’t show they were injured by the now-toothless mandate, as required under the Constitution.
“To find standing here to attack an unenforceable statutory provision would allow a federal court to issue what would amount to in advisory opinion without the possibility of any judicial relief,” Breyer wrote.
Breyer also rejected contentions by Texas and other suing states that they had standing. The states said the individual mandate is costing them money by causing more people to enroll in the Medicaid insurance program for the poor.
“A penalty might have led some inertia-bound individuals to enroll,” Breyer wrote. “But without a penalty, what incentive could the provision provide?”
Dissenting conservatives
Justices Samuel Alito and Neil Gorsuch dissented, saying they would have let the suit go forward and dismantled much of the law.
“No one can fail to be impressed by the lengths to which this court has been willing to go to defend the ACA against all threats,” wrote Alito, who was in dissent in both previous ACA cases.
In a concurring opinion, Justice Clarence Thomas said he agreed with Alito’s analysis of the previous cases, but agreed with the majority that the latest challengers lacked the right to sue.
The White House didn’t immediately respond to a request for comment on the court’s opinion.
The ACA expanded the Medicaid program for the poor, provided consumers with subsidies, created marketplaces to shop for insurance policies, required insurers to cover people with pre-existing conditions, and let children stay on their parents’ policies until age 26.
A federal appeals court had declared the individual mandate unconstitutional without the tax penalty and left doubt about the rest of the law. A group of Democratic-run states led by California and the U.S. House of Representatives defended the law.
Future litigation
Josh Blackman, a law professor at the South Texas College of Law Houston, said the court left the door open for another constitutional challenge in the future. If the federal government tries to enforce another provision of Obamacare against someone, that person could try to argue Obamacare’s individual mandate is unconstitutional and the entire law must fall, he said.
“This doesn’t resolve the validity of the ACA,” Blackman said. “It just sort of kicks it down the road.”
But Jonathan Adler, a law professor at Case Western Reserve University School of Law, said the only way the same argument could be raised is if the federal government tries to enforce the individual mandate.
“The government will not do that,” he said. “I don’t think that’s a risk.”
Texas could try to come back and show reams of evidence of how many people are going to enroll in its plans because of this mandate, but it’s unlikely, said Katie Keith, a health law professor at Georgetown University.
“I don’t think they can do that and I think the court here would even be skeptical about that,” she said. “I think it’s a very low risk that that happens but you never say never.”
While there may not be another broad constitutional challenge ahead, litigation over Obamacare will continue.
“There will not be a big omnibus challenge to the entire statute, but there will continue to be ongoing litigation about the administration and enforcement of the law, and that will go on for some time,” Adler said.
The case is California v. Texas, 19-840.
