The U.S. Supreme Court dismissed a case challenging the constitutionality of the Affordable Care Act in a 7-2 decision released Thursday morning.
The majority opinion in California v Texas found that the plaintiffs did not demonstrate sufficient injury to bring forward a case against the ACA.
The Affordable Care Act was in danger because of a provision within it in known as the “individual mandate,” which imposes a financial penalty on those who do not get health insurance. A Republican tax bill in 2017 reduced the penalty to $0, and a federal judge ruled that the entire law was invalid as a result in 2018.
Key provisions of the ACA that are closely tied to the individual mandate include coverage for people with pre-existing conditions, one of the most popular facets of the law, according to Kaiser Health News.
“I’m tremendously relieved for the patients of Connecticut as a consumer advocate, and as a lawyer, I am thrilled that a challenge that verged on the frivolous was thrown out,” said Ted Doolittle, the state’s healthcare advocate. “My only caveat is that it’s regrettable that even two justices of the U.S. Supreme Court would think that Congress did not have the authority to provide health care to every American.”
Going into Thursday, health law experts believed that the court was not likely to strike down the entire law. The Supreme Court had four questions to resolve sequentially over the course of its deliberations; the court had to rule in a particular way on all four questions for the ACA to be stripped down.
First, the court had to establish that the plaintiffs in the case had suffered sufficient injury to have a case at all; if the court ruled that they did not, the ACA would stand untouched.
Second, if the justices found that the plaintiffs had sufficient standing to sue, they would then have had to determine if the individual mandate was constitutional; if it was, the ACA would again stand untouched.
Third, if the justices found that the mandate was unconstitutional, they would then have to decide if the mandate could be severed from the rest of the law as a whole. If it could be, then once again, the Affordable Care Act would remain operational in its current form.
Fourth, if justices ruled that the mandate was both unconstitutional and inseparable from the rest of the law, then they would have to determine which parts of the law would go down with it. Legal scholars believed that it was highly unlikely that the Supreme Court would find the individual mandate both unconstitutional and inseparable from parts of the Affordable Care Act.
The court found that the plaintiffs did not have the standing to sue and did not proceed to rule on any of the other questions. “We proceed no further than standing,” Justice Stephen Breyer wrote in the majority opinion. He was joined by Justices John Roberts, Sonia Sotomayor, Elena Kagan, Brett Kavanaugh and Amy Coney Barrett. Justice Clarence Thomas filed a concurring opinion, and Justices Samuel Alito and Neil Gorsuch dissented.
This is not the first time that the Affordable Care Act has been tested before the Supreme Court. In 2012, the Supreme Court ruled in a 5-4 decision to uphold the Affordable Care Act, with Chief Justice Roberts casting the deciding vote with the more liberal members of the court. The court ruled that the individual mandate was not unconstitutional, describing it as a tax.
The addition of Justice Barrett to the bench after the death of Justice Ruth Bader Ginsburg last year shifted the balance of power towards conservatives in the nation’s highest court. Barrett had previously criticized Roberts’ position in the 2012 ACA ruling in a law article from 2017.
“In Connecticut, the ACA has been critical to our effort to reduce the uninsured rate in our state to around 5% through sign-ups on our nation-leading Access Health CT marketplace, and registrations in our Medicaid program,” said Gov. Ned Lamont. “With the Supreme Court reinforcing once again the legal foundation upon which the law was built, the millions of individuals and families across the country and in our state benefiting from the ACA’s healthcare reforms and expansions can rest easy tonight knowing their quality coverage will endure.”