SUPREME COURT BACKS “OBAMACARE”

Seven justices agreed that 18 Gop-led states and two individuals lacked the legal standing to sue.

WASHINGTON» — The Affordable Care Act on Thursday survived a third major challenge as the Supreme Court, on a 7-2 vote, turned aside the latest effort by Republicans to kill the health care law.

The legislation, former President Barack Obama’s defining domestic legacy, has been the subject of relentless Republican hostility. But attempts in Congress to repeal it failed, as did Supreme Court challenges in 2012 and 2015. With the passing years, the law has gained popularity and has become 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 and its potency as a political issue for Republicans reduced.

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 18 Republican-led states and two individuals who brought the case had not suffered the sort of direct injury that gave them standing to sue.

Chief Justice John Roberts, who 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.”

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 touch the larger issues in the case: whether the bulk of the law could stand without a provision that initially required most Americans to obtain insurance or pay a penalty.

“This ruling reaffirms what we have long known to be true: the Affordable Care Act is here to stay,” Obama said on Twitter.

In the 11 years since Obama signed the legislation into law, Republicans have assailed the Affordable Care Act as a step toward socialized medicine, government intrusion into health care decisions and a costly boondoggle.

They challenged it on a variety of fronts in the courts and made calls for its repeal a staple of their campaigns. But some of its provisions, such as coverage for preexisting conditions and for adult children up to age 26, proved popular across party lines. Even when they controlled the Senate, the House and the White House, Republicans failed to muster the votes to repeal the law — and despite former President Donald Trump’s promises to deliver a better alternative, he never produced a detailed proposal of his own.

While health care remains a potent political issue — and the Affordable Care Act has shortcomings Democrats have acknowledged — the latest court ruling suggests that Republican chances of winning a legal battle to kill it are now much diminished.

“With millions of people relying on the Affordable Care Act for coverage, it remains, as ever, a BFD,” President Joe Biden said on Twitter after the ruling, alluding to his obscenity-punctuated comment to Obama on the day in March 2010 the bill was signed into law that the legislation was

a big deal. Biden has signaled he now wants to build on the legislation through a series of steps to expand access to health care.

Republicans were critical of the decision but suggested the battle would now focus on the policy fight in Congress.

“The failed Obamacare system will stagger on as a result of this decision,” said Sen. John Barrasso, R-wyo.

“Every American’s health care has been harmed by Obamacare,” he said. “Republicans remain focused on making health care more affordable for families in Wyoming and around the country. Democrats keep pouring money into Obamacare instead of fixing the many problems facing patients and health care providers.”

The challengers in the case 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.

They 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 also must fall.

The challenge was largely successful in the lower courts. A federal judge in Texas ruled that the entire law was invalid, but he postponed the effects of his ruling until the case could be appealed. In 2019, the 5th U.S. Circuit Court of Appeals in New Orleans agreed that the mandate was unconstitutional but declined to rule on the fate of the remainder of the health law, asking the lower court to reconsider the question in more detail.

Breyer did not address most of the arguments that were the basis of those decisions, 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 suffer 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 state-sponsored 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 inertia-bound individuals to enroll. But without a penalty, what incentive could the provision provide?”