ACA is here to stay
In the latest attempt by Georgia to strike down the Affordable Care Act law, popularly known as Obamacare, the U.S. Supreme Court rejected Georgia’s challenge and upheld the law. Voting 7-2, the court ruled against the Peach State and several other states seeking to attack Obamacare as unconstitutional.
President Barack Obama signed this historic legislation in 2010 and critics have attempted three times to have the Supreme Court overturn it based on it being unconstitutional, which the High Court has rejected each time. Justice Stephen Breyer wrote for the court that the states and people who filed a federal lawsuit “have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.”
“Neither the individual nor the state plaintiffs have shown that the injury they will suffer or have suffered is ‘fairly traceable’ to the ‘allegedly unlawful conduct’ of which they complain,” Breyer wrote. Joining Breyer in his majority opinion were Justices Clarence Thomas, Sonia Sotomayor, Elena Kagan, Brett Kavanaugh, Amy Coney Barrett and Chief Justice John Roberts. Dissenting were Justices Samuel Alito and Neil Gorsuch.
The law’s major provisions include protections for people with preexisting health conditions, a range of no-cost preventive services and the expansion of the Medicaid program that insures lower-income people, including those who work in jobs that don’t pay much or provide health insurance. Also left in place is the law’s now-toothless requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero.
The elimination of the penalty had become the hook that Texas and other Republican-led states, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law should fall, too.
And with a more conservative Supreme Court that includes three Trump appointees, opponents of Obamacare hoped a majority of the justices would finally kill off the law they have been fighting against for more than a decade. But the third major attack on the law at the Supreme Court ended the way the first two did, with a majority of the court rebuffing efforts to gut the law or get rid of it altogether.
In dissent, Alito wrote, “Today’s decision is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue.” Alito was a dissenter in the two earlier cases, as well. Roberts said during arguments in November it seemed the law’s foes were asking the court to do work best left to the political branches of government.
Polls show the 2010 health care law grew in popularity as it endured the heaviest assault. In December 2016, just before Obama left office and Trump swept in calling the ACA a “disaster,” 46% of Americans had an unfavorable view of the law, while 43% approved, according to the Kaiser Family Foundation tracking poll. Those ratings flipped and by February of this year 54% had a favorable view, while disapproval had fallen to 39% in the same ongoing poll.
The health law is undergoing an expansion under President Joe Biden, who sees it as the foundation for moving the U.S. to coverage for all. His giant COVID-19 relief bill significantly increased subsidies for private health plans offered through the ACA’s insurance markets, while also dangling higher federal payments before the dozen states that have declined the law’s Medicaid expansion. About 1 million people have signed up with HealthCare.gov since Biden reopened enrollment amid high levels of COVID cases earlier this year.
The administration says an estimated 31 million people are covered because of the law, most through its combination of Medicaid expansion and marketplace plans. But its most popular benefit is protection for people with preexisting medical conditions. They cannot be turned down for coverage on account of health problems or charged a higher premium. While those covered under employer plans already had such protections, Obamacare guaranteed them for people buying individual policies.
Another hugely popular benefit allowed young adults to remain on their parents’ health insurance until they turn 26. Before the law, going without medical coverage was akin to a rite of passage for people in their 20s getting a start in the world.
Because of the ACA, most privately insured women receive birth control for free. It’s considered a preventive benefit covered at no additional cost to the patient. So are routine screenings for cancer and other conditions.