In Third Legal Ruling, U.S. Supreme Court Upholds ACA

For the third time on Thursday, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act (ACA), leaving in place the landmark law’s broad provisions on health care access and coverage originally enacted by Congress in 2010. The case, California v. Texas, was initiated by a coalition of 18 states and two individuals, led by Texas, and sought the entire elimination of the ACA on the grounds that the ACA could not stand on its own after Congress removed the individual mandate tax penalty in 2017. The Texas coalition case was consolidated with another case brought by 17 states, led by then-California Attorney General Xavier Becerra, seeking to protect the sweeping health reform law.

Leading up to the Supreme Court, the challenge against the ACA by Texas and other states was largely successful in lower courts, as evidenced by a Texas federal judge’s ruling in 2018 that the entire law was invalid and agreement by appellate justices in New Orleans in 2019 that the individual mandate was unconstitutional.

Thursday’s ruling by the Supreme Court did not align with rulings by lower courts and largely did not address most of the arguments advanced by the Texas coalition. Instead, the majority opinion of the court, drafted by Justice Stephen Breyer, found that the challenging states had no legal standing to bring the case to court because they had not shown a past or future injury as a result of the ACA’s individual mandate. Justice Breyer was joined in the opinion by Chief Justice John Roberts and Justices Clarence Thomas, Sonia Sotomayor, Elena Kagan, Brett Kavanaugh, and Amy Coney Barrett. Justices Samuel Alito and Neil Gorsuch dissented, arguing the law’s mandate was now unconstitutional without the penalty and could not be severed from the rest of the law.

Thursday’s ruling represents the third time the U.S. Supreme Court has upheld the ACA. Of note, each ruling over the years has gained support upholding the sweeping health care reform law. In 2012, the Supreme Court upheld the constitutionality of the ACA’s individual mandate and optional state Medicaid expansion on a 5-4 vote. In 2015, the Supreme Court ruled in a 6-3 vote that federal subsidies could be used in states that did not set up their own insurance exchanges. And on Thursday, the Supreme Court ruled in a 7-2 vote that the plaintiffs had no standing to challenge the ACA in court.

Dramatic, nationwide changes to health coverage and patient protections were expected if the Supreme Court ruled in favor of plaintiffs in the California v. Texas case. However, with the court’s Thursday ruling, health experts largely anticipate the ACA to be secure for the foreseeable future. In a statement on the ruling by President Joseph R. Biden, Jr., the president declared, “The Affordable Care Act remains law of the land. … Today’s decision affirms that the Affordable Care Act is stronger than ever, delivers for the American people, and gets us closer to fulfilling our moral obligation that, here in America, health care is a right and not a privilege.” Similarly, U.S. Health and Human Services Secretary Xavier Becerra issued a statement applauding the Supreme Court’s ruling and recommitting the Biden-Harris Administration to protecting the ACA.

The Supreme Court’s full ruling on the California v. Texas case is available here.