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, written by Justice Stephen Breyer, 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. They would have struck down the most popular parts of the law, including the provision barring discrimination based on preexisting medical conditions.
But the majority decision threw out the challenge to the law on the 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,' " but "No plaintiff has shown such an injury," the court said.
The result of the decision, according to most experts, is that Obamacare would appear to be secure for the foreseeable future.
"If Obamacare is going to be dramatically changed, that's something that Congress will have to do," said Case Western law professor Jonathan Adler. "The courts will police the enforcement of this law like it does every other large regulatory statute. But if the fundamentals are going to be changed, Congress is going to have to pass legislation to do that."
Former President Barack Obama hailed the court's decision on his signature legislative achievement.
"This ruling reaffirms what we have long known to be true: the Affordable Care Act is here to stay," he said on Twitter.
Today, the Supreme Court upheld the Affordable Care Act. Again. This ruling reaffirms what we have long known to be true: the Affordable Care Act is here to stay.— Barack Obama (@BarackObama) June 17, 2021
President Biden, in a statement, called the opinion "a major victory for all Americans benefiting from this groundbreaking and life-changing law."
Congressional Republicans, who made repealing the ACA a centerpiece of their political strategy, appear to have acknowledged that reality.
In a statement, Rep. Kevin McCarthy, the House Republican leader and two of his top aides, said the court's decision "does not change the fact that Obamacare failed to meet its promises and is hurting hard-working American families." The statement did not mention a vow to "repeal and replace" Obamacare, a longstanding Republican promise.
The mandate, the most controversial provision of the law, was again at the core of Thursday's decision. It required that people either buy health insurance or pay a penalty. In 2012, it was upheld by a 5-4 vote, with Roberts casting the decisive fifth vote, on the grounds that the 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 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.
Over 31 million Americans have access health insurance through the ACA — a record high since the law's inception, according to the White House. In addition, the Urban Institute reported 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 preexisting conditions.
Young adults are now permitted to stay on their parents' insurance until age 26; copays are not permitted for preventive care; and insurance companies can no longer put lifetime caps on benefits, are required to spend 80% of premiums on medical coverage and are barred from discrimination based on factors like gender.
In addition, Medicaid coverage was 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 benefited are many who lost their health insurance when they lost their jobs in the COVID-19 pandemic.
LEILA FADEL, HOST:
The U.S. Supreme Court today threw out the challenge to the Affordable Care Act, holding that the plaintiffs in the case lacked standing. The 7-2 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. Joining us now to explain the ruling is NPR legal affairs correspondent Nina Totenberg. Hello, Nina.
NINA TOTENBERG, BYLINE: Hey there.
FADEL: So Nina, this is the third time the court has upheld the law. What was the case before the court about this time?
TOTENBERG: Well, this was a challenge brought by states, principally by red states, who claimed that they were being harmed by the Affordable Care Act under the mandate provision that was thrown out in 2012 and that the - that was under severable from the rest of the law because it was totally intertwined with the law. So even though the court upheld it, these states said, the whole law should now be struck down because the mandate was actually eliminated by the Congress after it concluded four years into the law's experience that it was no longer necessary. And the Supreme Court said to the states and actually even a couple of individuals, sorry, you don't have any legal standing to challenge this law because you weren't injured at all. You didn't have to pay anything. You can't show any injury. And therefore, we only decide actual cases where somebody has been harmed, and goodbye.
FADEL: So then what are the implications of today's ruling?
TOTENBERG: Well, over 31 million Americans access health insurance through the ACA and will now be able to continue to do so. That 31 million is a record high. Many of the provisions of the ACA are now taken for granted and could have been struck down. Up to 135 million people are covered by the ban on discrimination against those with preexisting conditions. Young adults are permitted to stay on their parents' insurance until age 26. Copays aren't permitted for preventive care. No longer are insurance companies permitted to put lifetime caps on benefits, et cetera, et cetera, et cetera. All of that could have been struck down under the theory of the red states who brought this case. But in fact, they didn't prevail. The Supreme Court for the third time left this law intact, standing as it is. And I'm sure there will be challenges in the future and never say never, but it does seem that the court is uninterested in - at this point anyway - in striking down the ACA as it now exists.
FADEL: And this wasn't the only Supreme Court decision today. There was another ruling in favor of a Catholic group that wouldn't allow same-sex foster parents. How sweeping is this ruling?
TOTENBERG: This is a very long decision with lots of concurring opinions. And as we sit here right now, I actually can't tell you how sweeping it is. What I can tell you is that it is a major victory for those who claim religious exemptions in the free ex - on the grounds of the free exercise of religion against claims by LGBT communities that they should have equal access and the contracting rights of state and city governments. In this case, the city of Philadelphia said - had a rule and a statute, essentially a city statute, that said you can't discrimination - discriminate in contracting. And Catholic Social Services did that in the sense that it said, under our religious beliefs, we shouldn't be involved in certifying LGBT parents for foster care, and therefore we will not screen them, which is - they had a contract with the city to screen potential foster care parents. Now, no LGBT couple asked to be screened, but CSS still said we wouldn't screen them if they came. And the Supreme Court upheld their right to do that today. Just how far the court went - it certainly could have gone further, but it does look as if the court has given institutions like Catholic Social Services a fairly broad hand to have religious exemptions to state and city anti-discrimination laws.
FADEL: NPR legal affairs correspondent Nina Totenberg, thank you for your reporting.
TOTENBERG: Thank you. Transcript provided by NPR, Copyright NPR.