Affordable Care Act survives another Supreme Court challenge

The Supreme Court upheld the Affordable Care Act — also known as Obamacare — in a Thursday morning ruling, retaining health care for millions of Americans.

In a 7-2 ruling in California v. Texas, a majority of the court said that Texas and a number of other Republican-controlled states did not have standing in their case to overturn former President Barack Obama’s signature legislative achievement. A federal judge in Texas had ruled in favor of the challenge in 2018 and struck the entire health care law as invalid, but the decision never went into effect as appeals worked their way through the system.

Without protections for pre-existing conditions provided by Obamacare, the Kaiser Family Foundation estimated in 2016 that up to 52 million people could be denied coverage. Others would lose insurance if the Medicaid expansion that was adopted by dozens of states and D.C. is killed.

In an opinion authored by liberal Justice Stephen Breyer, the court concluded “that the plaintiffs in this suit failed to show a concrete, particularized injury fairly traceable to the defendants’ conduct in enforcing the specific statutory provision they attack as unconstitutional. They have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision. Therefore, we reverse the Fifth Circuit’s judgment in respect to standing, vacate the judgment, and remand the case with instructions to dismiss.”

Associate Justice Stephen Breyer sits during a group photo of the Justices at the Supreme Court in Washington, DC on April 23, 2021. (Erin Schaff/AFP via Getty Images)

The ACA had survived previous Supreme Court challenges, including in 2012 when Chief Justice John Roberts ruled with the four liberal justices to keep it in place. While this particular case was seen as weak and even called a “blunder” by the Wall Street Journal editorial page, the composition of the court had shifted right since that opinion was issued, with conservatives now holding a 6-3 majority.

The two dissents were Justices Samuel Alito and Neil Gorsuch, who argued that Texas did have standing. Justice Clarence Thomas, who ruled against the law in 2012, sided with the majority, as did Justice Amy Coney Barrett, who had opposed the court’s earlier ruling. In his dissent, Alito wrote that the court had pulled off an “improbable rescue” of the law.

When former President Donald Trump first took office in 2017, Republicans also held both chambers of Congress, giving them the power to overturn the law as they had campaigned on since its inception. Legislative efforts fell short and the attacks on the law actually improved its popularity, as it is now supported by a majority of Americans. One of the major issues for Republicans is they have never been able to put forth a suitable replacement that wouldn’t cost millions of people their health care coverage, with Trump’s promise that he was set to unveil a perfect plan that took care of everybody for a low price never fulfilled.

“Now, I have to tell you, it’s an unbelievably complex subject,” Trump said in February 2017. “Nobody knew health care could be so complicated.”

When Republicans passed their tax overhaul later in 2017, they included a repeal of the individual mandate, the penalty that required anyone who didn’t have health care to pay a fine to the government. The argument from the Republican states that was also supported by the Trump White House in a filing last year is that the law could not exist without that mandate.

U.S. President Donald Trump speaks at the National Governors Association meeting in the State Dining Room of the White House February 27, 2017 Washington, DC. (Aude Guerrucci-Pool/Getty Images)

“No further analysis is necessary; once the individual mandate and the guaranteed-issue and community-rating provisions are invalidated, the remainder of the ACA cannot survive,” wrote Solicitor General Noel Francisco last summer.

A number of Democratic states, led by California, rallied in support of the law.

“For over a decade, the ACA has been the law of the land, and today’s decision solidifies those protections for generations to come,” tweeted New York state attorney general Letitia James following the ruling. “We will always fight to defend access to the affordable health coverage Americans depend on.”