HHS Secretary Xavier Becerra calls ACA decision a victory for those with preexisting conditions

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The Supreme Court has upheld the Affordable Care Act by proceeding no further than denying standing to the Republican state plaintiffs. 

In a 7-2 decision Wednesday, Justice Stephen Breyer, writing for the majority, said the plaintiffs do not have standing because they have shown no past or future injury that can be traced to their claim that the ACA is unconstitutional because there is no longer a tax penalty for not having health insurance. 

The Supreme Court determined in California v. Texas that the more than a dozen Texas-led states and individuals lacked standing to challenge the Affordable Care Act. 

This is the third time the Supreme Court has handed up a ruling on the landmark 2010 ACA that was signed into law under President Barack Obama and then Vice President Joe Biden. Each time, the Justices have upheld the Affordable Care Act. 

The Justices first ruled in 2012, when they determined the ACA's individual coverage mandate was constitutional because of the tax penalty mandate. Congress had the authority to tax, they said in the 5-4 ruling. 

In King v. Burwell in 2015, the Supreme Court ruled that individual states that didn't build their own exchanges were still eligible for health insurance subsidies.

Yesterday, Justice Samuel Alito, writing for the minority and joined by Justice Neil Gorsuch said, "Today's decision is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue."

Justice Clarence Thomas, who voted with the majority, said that while there was much to commend Justice Alito's account of "our epic Affordable Care Act trilogy," the Republican state plaintiffs had not identified any unlawful action that had injured them.

"The plaintiffs failed to demonstrate that the harm they suffered is traceable to unlawful conduct. Although this Court has erred twice before in cases involving the Affordable Care Act, it does not err today," Thomas said

As the former Attorney General for California, Health and Human Services Secretary Xavier Becerra led the Democratic challenge to Texas. Becerra said as a member of Congress he also helped draft the ACA.

Becerra, and numerous health organizations, called the ruling a victory for Americans who have preexisting conditions and those worried about being able to afford health coverage. Many said the COVID-19 public health emergency has underscored the need for the ACA. 

"More than 133 million people with pre-existing conditions like cancer, asthma or diabetes can have peace of mind knowing that the health protections they rely on are safe. Women who need access to birth control, lifesaving maternity care and preventive care can rest easy, knowing that their care is protected and covered. Seniors and people with disabilities can breathe easy knowing their health protections will continue. Individuals who have faced discrimination can continue accessing care without fear. And people relying on Medicaid and Medicare should know these programs are stronger than ever," Becerra said.

WHY THIS MATTERS

President Biden has made the issue of strengthening the ACA part of his plan for affordable health insurance, giving Americans greater subsidies for coverage. He initiated a Special Enrollment Period through August 15 to get additional enrollees, particularly those who lost their employer-sponsored insurance due to COVID-19. More than one million people have signed up during the SEP.

Becerra has said that most consumers can find a plan on HealthCare.gov for $10 a month.

He said yesterday, "Now we can build on the Affordable Care Act by implementing the investments that President Biden has made in America's health with the American Rescue Plan."

THE LARGER TREND

In 2018, Texas and more than a dozen other states brought a lawsuit against HHS and the Internal Revenue Service seeking a declaration that the minimum essential coverage provision was unconstitutional due to lack of tax enforcement. This provision was not severable from the entire law, they said.

Congress got rid of the individual tax mandate in 2017. Democrat states, led by California, opposed the Texas argument.

In November 2020, during oral arguments, the Justices appeared favorable to keeping the ACA, even those Justices appointed by President Donald Trump, who it was thought could tip the decision towards ending Obama's signature health law. The court currently has a 6-3 conservative majority.

Much of the oral arguments' debate centered on whether Texas and the other plaintiffs had standing in the case, which turned out to be the deciding factor for the justices.

The GOP states argued the ACA had harmed them, since the ACA increased costs by increasing Medicaid enrollment.

REACTION

Matt Eyles, president and CEO of AHIP, said, "We believe the Supreme Court rightly concluded this case does not belong in court, as the challengers have not suffered any injury. The ACA remains the law of the land and a foundational component of healthcare and coverage for more than 300 million Americans. After a year filled with unprecedented loss, when reliable comprehensive health coverage has never been more important, this decision protects the stability of health coverage for people with pre-existing conditions, hardworking families, seniors, and other Americans who need it most."

Rick Pollack, president and CEO of the American Hospital Association, said, "The more than 30 million Americans who secured health insurance under the Affordable Care Act can again breathe a sigh of relief. But our work is far from over. We need to redouble our efforts to close coverage gaps and make care affordable and accessible for everyone, all while continuing to fight COVID-19 and encouraging more Americans to get vaccinated."

Dr. Gerald E. Harmon, president of the American Medical Association said, "With yet another court decision upholding the ACA now behind us, we remain committed to strengthening the current law and look forward to policymakers advancing solutions to improve the ACA. The AMA will continue working to expand access to health care and ensure that all Americans have meaningful, comprehensive, and affordable health coverage to improve the health of the nation. We have a plan – 2021 and Beyond: AMA's Plan for the Uninsured – to do just that."

Dr. Bruce Siegel, president and CEO of America's Essential Hospitals said, "Today's U.S. Supreme Court decision on the Affordable Care Act (ACA) is a decisive victory for patients, hospitals, and all who believe no one, especially people of limited financial means, should go without access to affordable healthcare. Through the ACA, our nation took a historic step toward realizing a world without barriers to a need as fundamental to living as shelter, food, and education. This ruling preserves important progress in our work to make that vision a reality."

Margaret A. Murray, CEO of the Association for Community Affiliated Plans said, "The Affordable Care Act has been subjected to more than 60 repeal votes in the House of Representatives, a 16-day government shutdown, and three Supreme Court cases. Nevertheless, it has persisted – with the help of a thumbs-down from Senator McCain."

COVID-19 has highlighted the importance of behavioral and mental healthcare. 

Jennifer F. Kelly, PhD, president of the American Psychological Association, said, "This decision will protect health and mental health care coverage for millions of Americans who would otherwise have no access to much-needed health insurance."

The American Academy of Family Physicians said, "The ACA provides access to affordable healthcare for people who may not otherwise have coverage, fully covers preventive services at no cost to patients, protects those with pre-existing conditions and creates a foundation for equal access to healthcare for everyone in America." 

"CareFirst is pleased that the key provisions of the Affordable Care Act remain in effect and will continue to promote access to affordable health insurance for the individuals we serve and all Americans," said Brian D. Pieninck, president and CEO of CareFirst BlueCross BlueShield. 

Dr, Richard Besser, president and CEO of the Robert Wood Johnson Foundation said, "The ACA is one of the most significant laws in generations. Since its passage, tens of millions of Americans – in particular people of color, those with low incomes and preexisting conditions, and young adults – have received quality, affordable health care coverage. States that have expanded their Medicaid programs under the ACA have provided health coverage to millions, leading to improved health outcomes and stronger state economies."

Physicians for Reproductive Health president and CEO Dr. Jamila Perritt said, "While this is a huge win, we continue to advocate for further expansion of healthcare coverage for patients who still lack care even as the ACA remains law of the land. We continue to push for equitable access to all healthcare, including contraceptive care, birth care, and abortion care, especially for communities who face the most barriers to health care due to systemic oppressions: Black people, Indigenous people, other people of color, young people, people with disabilities, and LGBTQ+ people."

Natalie Davis, cofounder and acting executive director of United States of Care said, "(The) Supreme Court ruling finally brings peace of mind to those who feared having their health care torn away by the courts."

ACHP president and CEO Ceci Connolly said, "We are hopeful that this historic decision will restore stability to the individual market – and be the push Washington needs to make true progress in building upon on what works and strengthening the ACA."

NEA president Becky Pringle said, "If there have been any lessons learned from the COVID-19 pandemic, it is that access to universal, quality and affordable healthcare is a matter of economic and national security. Today's decision by the court sends yet another clear message that there is no appetite – legal or otherwise – to dismantle health insurance on which more than 21 million Americans depend." 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com