High court nixes third challenge to Obamacare
WASHINGTON — The Affordable Care Act on Thursday survived a third major challenge as the Supreme Court turned aside the latest effort by Republicans to kill the health care law.
The law, President Barack Obama’s defining domestic legacy, has been the subject of relentless Republican hostility. But attempts to repeal it failed, as did two earlier Supreme Court challenges, in 2012 and 2015. With the passing years, the law gained popularity and was woven into the fabric of the health care system.
On Thursday, in what Justice Samuel Alito called, in dissent, “the third installment in our epic Affordable Care Act trilogy,” the Supreme Court again sustained the law. Its future now seems secure.
"There is a fundamental problem with the arguments advanced by the plaintiffs in attacking the act - they have not identified any unlawful action that has injured them."
Supreme Court Justice Clarence Thomas, in concurring opinion
The margin of victory was wider than in the earlier cases, with six members of the court joining Justice Stephen Breyer’s modest and technical majority opinion, one that said only that the plaintiffs had not suffered the sort of direct injury that gave them standing to sue.
Chief Justice John Roberts, who had cast the decisive vote to save the law in 2012, was in the majority. So was Justice Clarence Thomas, who had dissented in the earlier decisions.
“Whatever the act’s dubious history in this court,” Thomas wrote in a concurring opinion, “we must assess the current suit on its own terms. And, here, there is a fundamental problem with the arguments advanced by the plaintiffs in attacking the act — they have not identified any unlawful action that has injured them. Today’s result is thus not the consequence of the court once again rescuing the act, but rather of us adjudicating the particular claims the plaintiffs chose to bring.”
Justices Sonia Sotomayor, Elena Kagan, Brett Kavanaugh and Amy Coney Barrett also joined Breyer’s majority opinion. At Barrett’s confirmation hearings last year, Democrats portrayed her as a grave threat to the health care law.
The court did not reach the larger issues in the caseb whether the bulk of the law could stand without a provision that initially required most Americans to obtain insurance or pay a penalty.
Striking down the Affordable Care Act would have expanded the ranks of the uninsured in the United States by about 21 million people — a nearly 70% increase — according to recent estimates from the Urban Institute.
The biggest loss of coverage would have been among lowincome adults who became eligible for Medicaid under the law after most states expanded the program to include them. But millions of Americans would also have lost private insurance, including young adults whom the law allowed to stay on their parents’ plans until they turned 26 and families whose income was modest enough to qualify for subsidies that help pay their monthly premiums.
The stakes were especially high in California, which argued before the court on behalf of a group of 16 states, plus the District of Columbia, in support of the health care law.
Overturning the law would have cost California at least l30 billion a year it now receives in federal subsidies for 1.5 million residents who obtain health insurance through the state marketplace, Covered California, and 4 million additional residents who became eligible for MediCal under the law, said Anthony Wright, executive director of the advocacy group Health Access California.
Millions more are protected by the federal law’s ban on denial of coverage because of preexisting conditions, and by additional provisions against age and sex discrimination, Wright said. California has also extended coverage under the law to young undocumented immigrants, and the Legislature and Gov. Gavin Newsom are discussing expansion of coverage to undocumented senior citizens.
“California has done the most to implement” the Affordable Care Act, so “we had the most to lose,” Wright said.
In a statement, state Insurance Commissioner Ricardo Lara said, “The Affordable Care Act has helped millions of Californians to gain quality, affordable health care, which has been critical during a global pandemic that we haven’t seen in a more than a century.”
The plaintiffs — two individuals and 18 states — sought to take advantage of the 2012 ruling, in which Roberts upheld a central provision of the law, its individual mandate requiring most Americans to obtain health insurance or pay a penalty, saying it was authorized by Congress’ power to levy taxes.
The plaintiffs argued that the mandate became unconstitutional after Congress in 2017 eliminated the penalty for failing to obtain coverage because the mandate could no longer be justified as a tax. They went on to say that this meant the rest of the law must also fall.
Breyer did not address those arguments, focusing instead on whether the plaintiffs were entitled to sue at all.
The two individuals, he wrote, suffered no harm from a toothless provision that in effect merely urged them to obtain health insurance. Similarly, he wrote, the states did not sustain injuries tied directly to the elimination of the penalty that had been part of the individual mandate.
The states argued that the revised mandate would cause more people to take advantage of statesponsored insurance programs. Breyer rejected that theory.
“The state plaintiffs have failed to show,” he wrote, “that the challenged minimum essential coverage provision, without any prospect of penalty, will harm them by leading more individuals to enroll in these programs.”
“Neither logic nor intuition suggests that the presence of the minimum essential coverage requirement would lead an individual to enroll in one of those programs that its absence would lead them to ignore,” Breyer wrote. “A penalty might have led some inertiabound individuals to enroll. But without a penalty, what incentive could the provision provideAE”
In a vigorous dissent, Alito, joined by Justice Neil Gorsuch, said the third installment of the court’s Affordable Care Act trilogy “follows the same pattern as installments one and two.”
“In all three episodes, with the Affordable Care Act facing a serious threat,” he wrote, “the court has pulled off an improbable rescue.”