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US Supreme Court Votes to Sustain the Affordable Care Act

Advocate Masthead

July 16, 2021 (ACP) -- In mid-June, the U.S. Supreme Court in a 7-to-2 vote refused to overturn the Affordable Care Act (ACA), which has paved the way for tens of millions of Americans to get insurance coverage.

The American College of Physicians has supported the ACA since the beginning, and its advocacy crew is pleased with the Supreme Court decision. “Eliminating the coverage, benefits and protections provided by this law would have thrown our health care system into chaos, and placed health care for millions of Americans in jeopardy,” ACP President Dr. George M. Abraham said in a statement. “We are glad the justices saw the need for the law to remain in place.”

“The bottom line is the Supreme Court preserved the ACA,” said Bob Doherty, ACP senior vice president for governmental affairs and public policy. “This is great news, especially compared to what could have happened, although I don't think the days of litigation are over.”

The ACA has faced major challenges since it was signed into law 11 years ago. Three cases have made it to the Supreme Court. The most recent was filed by Republican governors, attorneys general and citizens who argued that it is unconstitutional to mandate that people buy health insurance with a penalty of zero dollars. (Congress had eliminated the penalty in response to another legal challenge.)

The plaintiffs also argued that the entire law could not stand without the mandate, and a Texas federal judge agreed. ACP worked with other supporters of the ACA to file a friend-of-the-court brief urging the Supreme Court to reject these claims and detailing the harm that a decision to do away with the ACA would have.

In its June ruling, the Supreme Court focused on whether the plaintiffs had standing to sue. The verdict: No. According to The New York Times, the majority opinion of the court was “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.”

The ruling is complex, Doherty said, “and in some ways, the court punted on the constitutional issues. But from our perspective, it's great news because the law stands.”

If the court had overturned the ACA, an estimated 21.1 million people would have lost health insurance, according to estimates from the Urban Institute. “The biggest loss of coverage would have been among low-income adults who became eligible for Medicaid under the law after most states expanded the program to include them,” The Times reported. “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.”

In addition, the newspaper reported, “a ruling against the law would also have doomed its protections for Americans with past or current health problems. The protections ban insurers from denying them coverage or charging them more for pre-existing conditions.”

The ACA is not entirely out of the woods yet. According to Doherty, the same Texas federal judge who ruled against the ACA is considering a case challenging the law's requirement that preventive care be provided at no cost to patients. “That case is percolating,” Doherty said. “We don't know whether it really has legs, or what would happen on appeal, or whether it would end up on the Supreme Court again. But for now, it does seem as those who want to use the courts to overturn the law don't have anywhere to go.”

The ACP advocacy team is not resting even though the status of the ACA appears to be secure. “We need to bring Medicaid expansion to more states and make sure the important health care provisions expanded by the latest $1.9 trillion COVID relief bill stay in place for good,” Doherty said. “We still have more work to do.”

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Back to the July 16, 2021 issue of ACP Advocate