WASHINGTON—The Supreme Court has dismissed a challenge by red states to Obamacare, preserving health insurance coverage for many millions of Americans.
Barely able to control his delight, White House Chief of Staff Ron Klain immediately tweeted: “It’s still a Big F—ing Deal,” referencing then-Vice President Biden’s 2009 remarks when the Affordable Care Act was first passed by the Congress under President Obama. Klain then noted that “thanks to the American Rescue plan,” the $2 trillion-dollar-plus bill successfully pushed by the Biden administration, the SCOTUS decision today safeguards the additional millions that have been able to sign onto Obamacare this year.
The 7 to 2 majority vote by justices left the entire Obamacare law intact by ruling that Texas, other Republican-led states, and two individuals had no right to bring their lawsuit in federal court. The ruling implies that there is nothing unconstitutional about the law, as red state Republicans have been claiming. It says that opposition to a law is not enough reason to come to the Supreme Court with a challenge—not when bodies representing majorities of Americans and the broad consensus in a democracy have stated through enactment of a law that they are in support of it.
Beyond saving Obamacare from right-wing attacks for the third time, the ruling today makes it more difficult to mount any future challenges against the law before the Supreme Court, as the justices implied by their ruling that state governments can’t simply decide against something that the wider country and democracy have decided to put into the law.
The decision says essentially that the law is constitutional, and it will be difficult if not impossible for any individual or official in opposition to the law to mount a successful challenge to it at the Supreme Court.
The law became increasingly popular with the public over the years as more people became aware of its provisions—including protections for people with pre-existing health conditions, a range of no-cost preventive services, and the expansion of the Medicaid program that insures lower-income people, including those who work in jobs that don’t pay much or provide health insurance.
Also left in place is the law’s now unenforceable requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero.
The elimination of the penalty had become the hook that Texas and other Republican-led states, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the original ACA when it was passed in 2010, the rest of the law should fall, too.
The ruling today was a blow to right wingers who have been opposing Obamacare from the beginning. They had hoped that a conservative Supreme Court that includes three Trump appointees would kill Obamacare altogether.
Trump’s three appointees to the Supreme Court—Justices Amy Coney Barrett, Neil Gorsuch, and Brett Kavanaugh—split their votes. Kavanaugh and Barrett joined the majority; Gorsuch was in dissent, signing on to an opinion from Justice Samuel Alito.
Justice Stephen Breyer, now considered among the most liberal on the Court, wrote for the court that the states and people who filed a federal lawsuit “have failed to show that they have the standing to attack as unconstitutional the Act’s minimum essential coverage provision.”
The dissenting Alito wrote, “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.” Alito was a dissenter in the two earlier cases, as well.
The closest the right wing ever came to actually destroying Obamacare was in July 2017, when Republican Arizona Sen. John McCain, who died a year later, cast a nationally-televised thumbs-down vote against a GOP repeal effort. His vote elicited a hysterical reaction from then-President Trump.
Chief Justice John Roberts hinted back in November where he stood on efforts to use the Supreme Court to kill the law when he said during arguments that it seemed the law’s foes were asking the court to do work best left to the political branches of government.
The Court’s decision preserves benefits that became part of the fabric of the nation’s health care system even as Republicans repeatedly tried to rip out Obamacare—in GOP Sen. Mitch McConnell’s words—“root and branch.”
The favorable SCOTUS ruling comes as Obamacare is now being expanded under the Biden administration, which says it intends to use the law as the basis of eventually expanding health care coverage to everyone in the U.S.
His giant COVID-19 relief bill significantly increased subsidies for private health plans offered through the ACA’s insurance markets, while also offering higher federal payments to the red states that have declined the law’s Medicaid expansion. Biden has had some success in the expansion effort. About one million people have signed up with HealthCare.gov since Biden reopened enrollment amid high levels of COVID-19 cases earlier this year.
The administration says an estimated 31 million people are covered because of the law, most through its combination of Medicaid expansion and marketplace plans.
Protection for people with pre-existing medical conditions remains the ACA’s most popular benefit. Thanks to that provision, people cannot be turned down for coverage by insurance companies on account of health problems or charged a higher premium. While those covered under employer plans already had such protections, Obamacare guaranteed them for people buying individual policies, too.
Another hugely popular benefit allows young adults to remain on their parents’ health insurance until they turn 26. Before Obamacare, going without medical coverage was the norm for people in their 20s getting their start in the world. People kept their fingers crossed and hoped they wouldn’t get sick.
Because of the ACA, most privately insured women receive birth control free of charge. It’s considered a preventive benefit covered at no additional cost to the patient. So are routine screenings for cancer and other conditions. These benefits of course have also come under sharp attack in states controlled by Republicans.
For Medicare recipients, Obamacare also improved preventive care, and more importantly, closed a prescription drug coverage gap of several thousand dollars that was known as the “doughnut hole.”
Dr. Kavita Patel, one of the architects of Obamacare, said today’s SCOTUS ruling “clearly puts to rest much of this opposition to the ACA. This is good news to the patients who rely upon it.”
This article features material from the Associated Press.
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