Supreme Court dismisses challenge to Affordable Care Act, leaving it in place

By Ariane de Vogue and Chandelis Duster, CNN

The Supreme Court on Thursday dismissed a challenge to the Affordable Care Act in a ruling that leaves the law intact and secures health insurance for millions of Americans. The judges turned down a challenge from the Republican-led states and the former Trump administration that asked the judges to block the entire law.

The judges said the 2010 law challengers did not have the right to start the case.

Judge Stephen Breyer wrote the ruling, which was 7-2. Judges Samuel Alito and Neil Gorsuch disagreed.

RELATED: Nothing Judge Stephen Breyer has said publicly suggests he is ready to quit

“With millions of people relying on the Affordable Care Act, it remains a BFD as always. And it’s here to stay, ”President Joe Biden tweeted Thursday, indicating he was caught by a hot microphone in 2010 telling President Barack Obama the law was a“ big deal ”.

The judges found that the provisions they challenged did not harm opponents, as Congress reduced the penalty for failing to take out health insurance to zero.

“For these reasons, we come to the conclusion that the plaintiffs in these proceedings have not proven any specific, concrete violation that can be adequately traced back to the defendant’s behavior in enforcing the specific legal provision that they have attacked as unconstitutional,” wrote Breyer. “They have not shown that they have the opportunity to attack the basic minimum coverage provision of the law as unconstitutional.”

The Department of Health and Human Services released a report earlier this month showing a record 31 million Americans have health insurance under the Affordable Care Act, including 11.3 million people enrolled on the Obamacare exchanges in February, and 14.8 million newly eligible, low-income individuals who enrolled in Medicaid expansion as of December.

In addition, another 1.2 million Americans have selected policies for 2021 during a special enrollment phase Biden launched in mid-February to expand coverage to uninsured people. It runs until mid-August.

Texas Attorney General Ken Paxton, who led the legal challenge to the law and led Republican efforts to overturn Obama-era policies in court, promised in a Twitter post on Thursday to continue fighting the law.

“If the government is allowed to mislead its citizens into getting a massive government takeover of health care and still survive after review by the Supreme Court, it will be the downfall for the principles of federalism and the limited Government, ”Paxton tweeted.

Decision about standing

“Today’s ruling is indeed another grace period for the Affordable Care Act – one based on the extent to which the provisions that critics call offensive are no longer enforceable against it,” said Steve Vladeck, CNN analyst and professor on the US Supreme Court of Texas University of Texas Law.

The verdict means that the judges do not decide on the merits of the complaint, but let the law stand.

“By finding that these individual plaintiffs and states fail to bring suit, the judges have avoided deciding whether the ACA, as amended, is constitutional – but it has also become much more difficult for anyone to face that issue Bringing judgment, ”said Vladeck. “Essentially, they have deoxygenated the ACA’s ongoing constitutional fire.”

Obama said the Supreme Court ruling confirms the law “is here to stay”.

“The principle of universal coverage was introduced, and 31 million people now have access to medical care through the law we passed – and millions more who can no longer be denied coverage or no longer billed because of an existing illness.” the former president said in a statement on Thursday.

Dr. Ezekiel Emanuel, who helped shape the law as an adviser to the White House under Obama, approved the 44th President on Thursday. The Supreme Court made it clear that the ACA is the law of the country.

“It will remain the law of the land. We’re not picking it up and we should be doing additional things now to improve the health system, ”Emanuel told CNN’s Poppy Harlow in the Newsroom.

“I think the problem is, let’s stop debating whether we can cover people through the Affordable Care Act? Will the exchange stay? Will the Medicaid extension stay? And let’s talk about the real problems of improving the health of the population… ”he added. “You made it clear, stop annoying us. This is a recurring fly. We won’t handle it. “

“An unlikely salvation”

In his dissent, Alito cited the various times the Supreme Court has ruled the law and found ways to keep it in effect.

“Today’s decision is the third part of our epic Affordable Care Act trilogy and follows the same pattern as parts one and two. In all three episodes where the Affordable Care Act was exposed to serious threats, the court delivered an unlikely rescue, ”Alito wrote.

“Nobody is impressed with the efforts this court has made to defend the Court of Auditors from all threats. A penalty is a tax. The United States is a state. And 18 states that are carrying costly burdens under the ACA cannot even get a foot in the door to pose a constitutional challenge, ”added the seasoned Conservative judge.

“So a no-tax tax can stand and support one of the greatest government programs in our nation’s history. Fans of legal ingenuity will applaud again, ”he added. “But I have to respectfully disagree.”

Third challenge

The case marked the third time the court heard a significant challenge to the law, despite the stakes stepping up amid the impact of Covid-19, catastrophic deaths and the current pressures on the healthcare industry. Texas and other Republican-led states, with the support of the Trump administration, challenged the law, which was being defended by California and other Democratic-led states, as well as the House of Representatives.

In 2012, Roberts cast the casting vote in a 5-4 decision that stunned Republicans when he found that the law’s individual reporting mandate was valid under the tax jurisdiction of Congress. By 2017, as part of the year-end tax reform, Republican-led Congress reduced the tax penalty to zero for those who did not have insurance.

The Republican-led states, backed by the Trump administration, sued and argued that since the mandate was no longer tied to a specific tax penalty, it had lost its legal basis. They also argued that all law, including protection for people with pre-existing conditions, should fall because the individual mandate is intertwined with a host of other provisions.

In December 2019, a federal appeals court declared the individual mandate to be unconstitutional. But the court critically examined whether the rest of the massive law – even provisions unrelated to the mandate – could remain on the books.

In court, Texas Attorney General Kyle D. Hawkins said the 2017 amendment made the individual mandate unconstitutional. “It is a bare order to get health insurance, and as such it falls outside the enumerated powers of Congress,” he said. “The right way is to take Congress at its word and declare the mandate unconstitutional and inseparable from the rest of the Court of Auditors,” he said.

The then acting Attorney General Jeffrey Wall sided with Texas on this issue, arguing that the mandate “exceeded” the powers of Congress.

During his tenure, former President Donald Trump repeatedly said he would propose an alternative but did not give out any essential details.

Proponents of the Affordable Care Act believed the court should uphold all of the law, but conceded that judges could remove the mandate but leave the rest of the law in place.

“Congress made a single surgical change,” California Attorney General Michael Mongan told judges. He stressed that the remainder of the law should remain in place if the mandate is canceled, “because that is exactly the framework that Congress itself has already put in place”.

Former US attorney general Donald Verrilli also argued on behalf of the House of Representatives that the two individuals and the Republican-led states did not have the necessary violations of law to file the lawsuit. He said that once Congress reduced the penalty to zero, those who refuse to get health insurance would stop paying tax for not doing so.

“There was no way Congress would have wanted an outcome that would throw 23 million people out of their insurance, end protection for people with pre-existing conditions and create havoc in the healthcare sector,” he said.

Twice in their previous tenure, judges relied on severability doctrine to save laws after declaring individual provisions unconstitutional. In one case, Roberts wrote, “We think Congress would prefer to use a scalpel rather than a bulldozer.”

This story has been updated to include additional background information and responses.

The CNN Wire
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CNN’s Dan Merica contributed to this report.