The U.S. Supreme Court upheld the Affordable Care Act for the third time on Thursday, leaving in place the broad provisions of the law enacted by Congress in 201o. The vote was 7 to 2.
The opinion was authored by Justice Stephen Breyer who was joined 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.
The decision threw out the challenge to the law, on grounds that Texas and other objecting GOP-dominated states were not required to pay anything under the mandate provision and thus had no standing to bring the challenge to court.
"To have standing, a plaintiff must 'allege personal injury fairly traceable to the defendant's allegedly unlawful conduct and likely to be redressed by the requested relief,'" the majority wrote. "No plaintiff has shown such an injury 'fairly traceable' to the 'allegedly unlawful conduct' challenged here."
The mandate, the most controversial provision of the law, required that people either buy health insurance or pay a penalty. In 2012, it was upheld by a 5-to-4 vote, with Chief Justice John Roberts casting the decisive fifth vote, on the grounds that penalty fell within the taxing power of Congress.
In 2017, however, Congress got rid of the penalty after the Congressional Budget Office concluded that the law would continue to function effectively even without it. That prompted the challengers to go back to court, contending that because the penalty had been zeroed out, it was no longer a tax or a mandate. What's more, they contended, because the mandate was so interwoven with the rest of the ACA, the whole law must be struck down in its entirety.
But the high court instead threw out the challenge to the law, on grounds that Texas and other objecting states lacked legal standing; because those states were not required to pay anything under the mandate provision, they could not show any injury, the court said.
Over 31 million Americans access health insurance through the ACA - a record high since the law's inception, the White House said last week. In addition, the Urban Institute reported in in May that ACA premiums have gone down each of the last three years.
Many of the provisions of the ACA are now taken for granted. Up to 135 million people are covered by the ban on discrimination against those with pre-existing conditions.
Young adults are now permitted to stay on their parents' insurance until age 26; co-pays are not permitted for preventive care; no longer are insurance companies permitted to put lifetime caps on benefits; insurers are required to spent 80 per cent of premiums on medical coverage; and they are barred from discrimination based on factors like gender.
In addition, Medicaid coverage greatly expanded after all but a dozen states took advantage of the ACA to expand federally subsidized coverage under the program. Among those who have benefitted are many who lost their health insurance when they lost their jobs in the COVID-19 epidemic.
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