WASHINGTON – The Affordable Care Act weathered a third major challenge on Thursday when the Supreme Court voted 7-2 in favor of Republicans' recent efforts to kill the Health Act.
Legislation, the defining domestic legacy of President Barack Obama, has been the subject of relentless Republican hostility. But attempts in Congress to overturn it failed, as did two previous Supreme Court challenges in 2012 and 2015. Over the years, the law gained popularity and was incorporated into the fabric of the healthcare system.
On Thursday, the Supreme Court re-affirmed what Judge Samuel A. Alito Jr. deviantly referred to as "the third part of our epic trilogy of the Affordable Care Act." Their future now seems secure and their potency as a political issue for the Republicans reduced.
The victory was greater than the previous cases as six members of the court joined the humble and technical majority opinion of Judge Stephen G. Breyer, which only stated that the 18 Republican-led states and two individuals who had brought the case did so had not suffered the kind of direct injury that enabled them to sue.
Chief Justice John G. Roberts Jr., who cast the decisive vote to save the law in 2012, was in the majority. As did Judge Clarence Thomas, who disagreed on previous decisions.
“Whatever the dubious story of the crime in this court,” wrote Judge Thomas in a unanimous statement, “we must judge the current lawsuit on its own terms. And here there is a fundamental problem with the arguments of the plaintiffs attacking the crime – they have not identified any illegal activity that harmed them. "
Judges Sonia Sotomayor, Elena Kagan, Brett M. Kavanaugh and Amy Coney Barrett also supported Justice Breyer's majority opinion. At Justice Barrett's confirmatory hearings last year, the Democrats portrayed them as a serious threat to health law.
The court failed to address the bigger questions in the case: whether most of the law could exist without a provision requiring most Americans to first purchase insurance or pay a fine.
"This ruling confirms what we have long known to be true: The Affordable Care Act is here to stay," Obama said on Twitter.
In the eleven years since Obama signed the law, Republicans have attacked the Affordable Care Act as a move toward socialized medicine, government interference in health decisions, and an expensive boondoggle.
They have challenged it in court on various fronts, making demands for its repeal an integral part of their campaigns. But some of its provisions, such as coverage for pre-existing conditions and for adult children up to the age of 26, proved popular across party lines. Even when they controlled the Senate, House of Representatives, and White House, Republicans failed to get the votes to repeal the law – and despite President Donald J. Trump's promises to provide a better alternative, he never has one own detailed proposal submitted.
While health care remains a major political issue – and the Affordable Care Act has flaws that Democrats have admitted – the recent court ruling suggests that Republicans' chances of winning a lawsuit are now severely reduced.
"With millions of people relying on the Affordable Care Act, it remains a BFD as always," President Biden said on Twitter after the ruling, alluding to his obscene comment to Mr Obama on the day in March 2010 when the bill was signed that the legislation was a big deal. Mr Biden has indicated that he is now looking to build on the legislation through a series of steps to expand access to health care.
Republicans were critical of the decision, but suggested that the struggle would now focus on the political struggle in Congress.
"The failed Obamacare system will tumble because of this decision," said Senator John Barrasso, Republican from Wyoming.
"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 across the country. Democrats are continuing to put money into Obamacare instead of solving the many problems that patients and healthcare providers face. "
The challengers in the case attempted to take advantage of the 2012 ruling in which Presiding Judge Roberts upheld a key provision of the law, whose individual mandate required most Americans to purchase health insurance or pay a fine, and said it was from the power of Congress has been empowered to collect taxes.
They argued that the mandate became unconstitutional after Congress abolished the penalty for lack of insurance in 2017 because it could no longer be justified as a tax. They went on to say that this meant that the rest of the law must also fall.
The challenge was largely successful in the lower courts. A federal judge in Texas ruled the entire law was invalid, but he postponed the effects of his ruling until the case could be appealed. In 2019, the United States Appeals Court for the Fifth District in New Orleans agreed that the mandate was unconstitutional, but declined to rule on the further fate of the Health Act and asked the lower court to consider the matter further .
Judge Breyer did not address most of the arguments underlying these decisions, but instead focused on whether the plaintiffs were allowed to sue at all.
The two people, he wrote, suffered no harm from a toothless preventive care system that basically only pushed them to take out health insurance. Likewise, he wrote, the states suffered no injuries directly related to the abolition of the penalty that was part of the individual mandate.
The states argued that the revised mandate would encourage more people to take up government-sponsored insurance programs. Judge Breyer rejected this theory.
"The prosecutors have not shown," he wrote, "that the contested minimum coverage requirement with no prospect of punishment will harm them by getting more people to sign up for these programs."
"Neither logic nor intuition suggests that having the minimum basic service requirement would cause a person to sign up for one of those programs that they would ignore for lack of it," wrote Judge Breyer. “A penalty could have resulted in some inertia individuals signing up. But what incentive could the provision without penalty offer? "
In a staunch dissent, Judge Alito, along with Judge Neil M. Gorsuch, said that the third installment of the Tribunal's Affordable Care Act trilogy "follows the same pattern as Installments 1 and 2."
"In all three episodes in which the Affordable Care Act was exposed to serious threats," he wrote, "the court made an unlikely rescue."
Judge Alito wrote that the court has routinely determined that states have the power to challenge federal initiatives. "Only recently," he wrote, "were New York and certain other states allowed to contest the inclusion of a citizenship issue in the 2020 census, even though the implications for them would depend on a speculative chain of events."
He said there were "novel questions" as to whether individual plaintiffs could sue. But "the states stand for reasons that are simple and meritorious," he wrote. "The opposite view of the court is based on a fundamental distortion of our settled case law."
Contrary to the majority, Judge Alito addressed the larger issues in the California v Texas Case No. 19-840, saying the mandate was now unconstitutional and could no longer be separated from the rest of the law.
Had Judge Alito's view prevailed, the country's health system would have experienced an earthquake.
The abolition of the Affordable Care Act would have added about 21 million people to the uninsured in the United States – an increase of nearly 70 percent – according to recent estimates by the Urban Institute.
The largest insurance loss would have occurred among low-income adults who were legally eligible for Medicaid after most states expanded the program to include them. But millions of Americans would also have lost their private insurance, including young adults who were legally allowed to stay on their parents' plans until the age of 26, and families whose incomes were modest enough to qualify for subsidies to pay theirs qualify monthly bonuses.
A verdict against the law would also have doomed its protection for Americans with past or current health problems. The protective measures prohibit insurers from refusing them coverage or charging them more for previous illnesses.
"Today's decision means that all Americans continue to have the right to access affordable and non-discriminatory care," said Xavier Becerra, the Minister for Health and Social Affairs who previously helped California's attorney general on Thursday's case defend.
Mr Biden has said he wants to build on the Affordable Care Act through moves like expanded health insurance grants, and some Democrats are pushing for bigger proposals like extending Medicare coverage to more people.
Republicans suggested Thursday that their focus would now be less on repealing the law and more on the debate in Congress and campaigning for 2022 on how to address issues like health insurance affordability.
"Although the Supreme Court ruled today that states have no power to challenge the mandate, the ruling does not change the fact that Obamacare has broken its promises and hurt hard-working American families," the top three Republicans in the House of Representatives shared the representatives Kevin McCarthy, Steve Scalise and Elise Stefanik in a statement. "Now Congress must work together to improve American health care."