In a 72-page opinion today, the U.S. Supreme Court upheld the Affordable Care Act again, rejecting the arguments made by Texas and 17 other states (including Arizona) that the Affordable Care Act is unconstitutional.

The Court upheld the ACA back in 2012 finding that the tax penalty for not having health insurance was well within Congress’ authority, and that therefore, the ACA was constitutional (except that the court held that states could not be compelled to expand Medicaid). The 2012 Supreme Court opinion rejected the argument that Congress’ authority to regulate interstate commerce made the ACA constitutional.

The Plaintiffs (including Attorney General Brnovich) in todays California v. Texas case argued that Congress’ authority to pass the ACA was eliminated when the penalty (tax) for not having health insurance went to 0 after Congress passed the 2017 tax cut law.

Here’s an analysis of today’s case by James G. Hodge, Jr., JD, LLM, a Peter Kiewit Foundation Professor of Law at ASU’s Sandra Day O’Connor College of Law:

California v. Texas (U.S. Supreme Court, June 17, 2021): In a brief, 7-2 majority Opinion, the U.S. Supreme Court rejected all constitutional and other claims brought against the continued enforcement and implementation of the Affordable Care Act’s (ACA) individual mandate, dismissing multiple state and individual plaintiffs’ claims for lack of standing. Justice Breyer, writing for the majority, concludes “the plaintiffs . . . failed to show a concrete, particularized injury fairly traceable to enforcement of the individual mandate provision of the ACA.”

Since Congress zeroed out the penalty for the individual mandate through the Tax Cuts and Jobs Act of 2017, individuals cannot assert a specific injury because the mandate can no longer be enforced. As for Texas and 17 other states’ alleged injuries the Court viewed their claims as similarly specious. States “have failed to show that the challenged minimum essential coverage provision, without any prospect of penalty, will harm them by leading more individuals to enroll in these programs.”

In a biting, dissenting opinion, Justices Alito and Gorsuch criticize the Court for brokering an “improbable rescue” of the ACA (as per its prior Opinions) through a “fundamental distortion” and “flat-out misstatements” of long-standing jurisprudence on standing. In essence, as Justice Alito argues, the injuries alleged by the states related to ACA implementation are directly “traceable,” or at least sufficiently tied to, the unlawful mandate provisions.

Determining the lawfulness of the ACA’s individual mandate is the only way to redress these injuries. While the dissent deems the mandate unconstitutional, along with the rest of the ACA, the majority disagrees, and the case is dismissed.

The ACA led to tremendous gains in the rate of children’s health coverage in Arizona. As CAA’s most recent KIDS COUNT Data Book demonstrates, the rate of uninsured children in our state dropped from 13% in 2012 to 8% in 2018. While funding for outreach and enrollment support has been cut, anti-immigrant rhetoric and policies, such as the new public charge rule, has deterred many families from enrolling in health care.

The Urban Institute recently projected that more than 21M Americans will be newly uninsured in 2022, including 1.7 million children if the ACA had been overturned by the Supreme Court. Those most at risk of losing coverage are people with incomes below 200% of the federal poverty level and people of color. In Arizona alone 223,000 non-elderly individuals are likely to become uninsured if the ACA is repealed.

Other key protections that would have been lost if Attorney General Brnovich had been successful in finding the ACA is unconstitutional include:

  • A guarantee that plans cover the 10 essential health benefits;

  • Marketplace insurance plans and the subsidies that make them more affordable;

  • Protections for pre-existing conditions and a guarantee that folks with pre-existing conditions can’t be charged more;

  • Medicaid expansion;

  • The ability to keep dependents on health insurance plans until they’re 26The chance to keep dependents with disabilities on your insurance indefinitely, and

  • A host of other wellness incentives (and a whole lot more).

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