Supreme Court Appears Poised to Keep ACA

Early reports on the Supreme Court’s first hearing regarding a new case against the Affordable Care Act (ACA) seem to point to the law surviving. Instability and uncertainty in healthcare have proven long-term themes, much to the dismay of those in the industry. The ACA was designed to fix the instability part, to which it has shown limited success. The uncertainty element has stubbornly continued as Republicans continually attempt to repeal or gut the law. 

In the latest attempt, California v. Texas, a group of Republican Attorney Generals, supported by the Trump administration, sought to declare the entire ACA unconstitutional. Their argument relies on the fact that Congress zeroed the insurance mandate penalty in 2017. A 2012 Supreme Court decision stated that the mandate was constitutional based on Congress’ power to tax. However, now that the “tax” is $0, they believe that ruling no longer applies and the entire law should be struck down.

A district court in Texas agreed with the Republican argument. Democrat controlled states led by California quickly appealed to a circuit court. That court agreed that the individual mandate was unconstitutional, but disagreed that the entire law should therefore be voided. The case was then forwarded to the Supreme Court, where initial arguments were presented on November 10th. 

The defenders of the law grew optimistic when conservative justices John Roberts and Brett Kavanaugh seemed to imply during the opening hearing that they believed the bulk of the law should be severed from the individual mandate if and when it is determined unconstitutional. Justice Roberts noted that Congress specifically voted to repeal the mandate penalty, but did not vote to repeal the law, implying that he does not believe it is within the courts directive to do so.

The issue of standing is also at play. Critics of the case believe that the original plaintiffs do not have standing to sue. Plaintiffs are supposed to be able to prove they have been harmed by a law in order to do so. The ACA’s defendants argue that the plaintiffs have not been harmed since there is no penalty for disobeying the mandate.

A final decision on the case is not expected until next summer, so the healthcare industry will have to accept more uncertainty as it continues to deal with the COVID-19 pandemic.