Supreme Court Tosses Challenge to ACA for Lack of Standing

This story has been updated.

In a 7 to 2 decision, the Supreme Court ruled Thursday that the Affordable Care Act (ACA) will stand, as plaintiffs seeking to declare the law unconstitutional did not have standing. The decision was delivered by Justice Stephen Breyer.

In the decision, the 3 justices appointed to the Supreme Court by then-President Donald Trump—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.

It is the third time the landmark law has survived a constitutional challenge since it was signed in 2010.

At issue in the case of California v Texas was whether the ACA’s individual mandate remained constitutional after Congress set the penalty to $0 in the 2017 tax overhaul bill, and if not, whether the rest of the ACA’s provisions could be severed.

But there were also questions as to whether the plaintiffs had the standing to file the sui, which was brought by a coalition of Republican states and with the support of the Justice Department under the previous administration.

During the oral argument last fall, the justices appeared dubious that the court should strike down all or parts of the ACA, even if the mandate was found to be unconstitutional.

Breyer wrote in the decision that the states and people who filed a federal lawsuit “have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.”

In dissent, Alito, who dissented in the earlier 2 cases, 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.”

If the law had been struck down, numerous efforts and initiatives to improve access to health care, improve quality, and increase value-based care (VBC) would have lost their legal underpinning, including Medicaid expansion; protections for individuals with pre-existing health conditions; no-cost preventive services; a pathway for approval for biosimilars in the United States; and the Center for Medicare and Medicaid Innovation, which fosters alternative payment arrangements in Medicare and Medicaid to help drive VBC.

One of the most popular provisions of the ACA allows young adults to remain on their parents’ health plans until age 26.

Between 2010 and 2016, the number of nonelderly uninsured adults fell 41%, from 48.2 million to 28.2 million.

Earlier this month, the Biden administration announced that 31 million Americans have health coverage through the ACA, including 1.3 million who enrolled in marketplace plans after February and 14.8 million people enrolled in Medicaid as a result of expansion of the program in December 2020 as part of the American Rescue Plan.

“Today’s Supreme Court ruling once again underscored the incredible strength of the ACA. A record 31 million people have enrolled in health care through the law – 1.2 million more signed up using the special enrollment period, open through 8/15,” the White House tweeted Thursday.

In December 2018, a federal judge in Texas ruled that when the penalty for not having health insurance was removed, the individual mandate became unconstitutional, and without the individual mandate, the rest of the ACA is invalid because the mandate was “essential” to the health law.