SCOTUS Hears Another GOP Case Trying to Repeal Obamacare

The Supreme Court is once again hearing another GOP-led case which could determine the future of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, which provides health insurance to over 23 million Americans and ensures that all Americans with preexisting medical conditions can still purchase health insurance plans. As of writing, over 38 states, including some very conservative states, have expanded Medicaid via the ACA to allow cheaper health care coverage to more Americans.

The ACA is one of the most significant health care reform bills passed since the passage of Medicare and Medicaid in 1965. It was passed when the Democrats briefly held a veto-proof majority in the Senate in 2010. It is a 900-page act which, aside from the removal of the individual mandate in 2017 (and is still being discussed in court), remained largely intact despite the attempts to strike it down in court. In summary, the law makes affordable health insurance available to many more people (especially those with incomes between 100 and 400 percent of the federal poverty level and with preexisting medical conditions), expands Medicaid (in states that choose to) to cover all adults with incomes below 138 percent of the federal poverty level, and generally tries to lower the cost of health care.

As of writing, 38 states have expanded Medicaid. (Note that despite not fully expanding Medicaid, Wisconsin doesn’t have any coverage gaps—people who are unable to obtain health insurance. It is the only state with this status.) Oklahoma and Missouri have passed ballot measures earlier this year to expand Medicaid, though the provision has not yet come into effect. That just leaves South Dakota, Wyoming, Kansas, Texas, and the Deep South to expand Medicaid. So far, no attempt at expanding Medicaid has failed.

This is the third time already that the Republicans have tried to strike down the ACA in the courts (previously in 2012 and 2015), having failed to repeal it in Congress various times (there is a whole Wikipedia page of all the times the GOP has tried, but failed, to repeal the act. The number of times this has been tried is over 70). Should the ACA be struck down, over 23 million people will lose their health insurance.

This attempt by the GOP to remove health insurance from 23 million Americans comes during a global pandemic that has cost the lives of 240,000 Americans, in which health care is in high demand.

Last month, when Amy Coney Barrett was nominated onto the nation’s highest court, many feared that it was a nomination intended to ensure that the ACA would be struck down. However, it seems that the law may once again be saved.

Let’s take a look at how this case ended up once again in the Supreme Court to understand why.

In late 2017, the Republican-controlled Congress passed the Tax Cuts and Jobs Act, which among other things, got rid of the individual mandate provision in the ACA. This is a provision that requires all citizens and legal residents of the United States purchase health insurance or pay a penalty to the government. (This mandate is mired in controversy which will be discussed in a later post.)

After the mandate was removed with the passage of the aforementioned Act in 2017, Texas, along with 19 other states, filed a lawsuit in the U.S. District Court for the Northern District of Texas challenging the constitutionality of the entire ACA following the removal of the individual mandate. The district judge, Reed O’Connor, ruled that the ACA was unconstitutional, but did not immediately overturn the law.

By January 2019, California, along with 17 other states, filed an appeal for O’Connor’s decision in the U.S. Court of Appeals for the Fifth Circuit after the Department of Justice said it would not challenge the ruling. At this point, it was evident that the case would make it to the Supreme Court and would probably be heard around the 2020 election season. In February, four more states joined California’s defense of the ACA, bringing the number to 21. It was around March that the DOJ, led by President Trump’s cabinet, announced that it would support Texas in eliminating the law. The Fifth Circuit court announced in mid-December the same year that they believed that some parts of the ACA, along with the individual mandate, were unconstitutional and sent it back to the District Court.

In response to the Fifth Circuit’s decision, the California coalition petitioned the Supreme Court of the United States on Jan. 3, 2020 to hear the case on an expedited basis (probably to stop the case from interfering in the November elections) and to uphold the ACA and overturn the lower courts’ decisions. The Texas coalition also petitioned the court to hear the case but asked the court not to expedite the case and also to affirm lower courts’ rulings on the unconstitutionality of the ACA.

In March, the justices agreed to hear both cases in the 2020-2021 court term, and the cases were consolidated under the case of California v. Texas. A map of the plaintiffs (those who want the ACA to be upheld) in yellow and the defendants (those who want the ACA to be repealed) in green is shown below. Gray states did not take part in this case.

Oral arguments for California v. Texas were heard on November 10, 2020. Conservative-leaning Chief Justice John Roberts and Trump-appointed Justice Brett Kavanaugh suggested that it wasn’t the court’s role to invalidate the ACA, signaling that even if some provisions are deemed unconstitutional and struck down, the majority of the ACA will survive.

Roberts said that, for example, since Congress only removed the individual mandate in the Tax Cuts and Jobs Act of 2017, it was clear that Congress was not trying to repeal the rest of the act, and wanted the court to do it. But he also said that “it isn’t our job” to repeal the ACA.

The California coalition also said that, in the act’s defense, that since the mandate was removed, there was no penalty (and thus no injury), thereby making the case invalid, and suggested the court throw the case out. The coalition also argued there is simply no reason to remove a bill that provides health coverage to 23 million Americans and ends protections for people with preexisting conditions if no one is being “injured” (taxed).

In addition, the justices also said that since the mandate was removed in 2018, it is clear that the mandate was not a necessary, essential part of the ACA to keep it running, and thus telling the Texas coalition that their argument that the mandate was essential to the operation of the act was flawed.

It now seems likely that the Roberts Court will once again uphold the constitutionality of the ACA, a cornerstone of the U.S. health system. The 23 million Americans that rely on the ACA for health care coverage should be able to once again be relieved that their insurance is here to stay.

More cases on the Supreme Court will come soon. Also, check out this post explaining why America’s health care system is in need of reform.