The Affordable Care Act Survives Another (and Perhaps Final?) Constitutional Challenge

By and
June 17, 2021

The U.S. Supreme Court declined to strike down the Affordable Care Act once again today, the third unsuccessful constitutional challenge to the far-reaching health care law since it was enacted in 2010. This time, the seven-justice majority dispatched the claims on purely technical grounds and did not even reach the substantive issues.

It was the first time the Supreme Court ruled on the ACA’s legality since Congress eliminated the penalty for failing to secure health insurance, an amendment that gutted the so-called “individual mandate.” Looking to capitalize on the unsettled statutory scheme, the plaintiffs, a group that included 18 states, argued that the remainder of the law was “inseverable” from the newly unenforceable mandate and had to fall along with it.

But today’s majority opinion did not address the severability issue, instead foreclosing the need for dealing with severability by holding that the plaintiffs lacked standing. It rejected the argument that the minimum coverage provision, shorn of its associated penalty, harmed the plaintiff states by inducing more citizens to enroll in public programs.

The decision preserves a host of protections and entitlements that are by now firmly entrenched in the American health care delivery regime—protections for those with preexisting conditions and a provision that allows young adults to stay on their parents’ insurance until age 26, health insurance subsidies for certain low income families and the state-administered Medicaid expansion. It also preserves the various requirements the ACA imposes on employers. Nothing will change, and it’s starting to look like the law is safe from constitutional challenge.

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