Supreme Court Upholds the Affordable Care Act for the Third Time

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Key Takeaways

  • The U.S. Supreme Court voted 7-2 to uphold the Affordable Care Act (ACA), also known as Obamacare.
  • The case was the third to reach the Supreme Court since the act was passed into law in 2010. 
  • Health policy experts think that future challenges to the ACA will be about specific parts of the law rather than new pushes to fully end the law.

On June 17, 2021, the Supreme Court of the United States voted (7 to 2) to dismiss a suit brought by Texas and several other states to find the Affordable Care Act (ACA) unconstitutional.

In a statement released after the ruling was issued, Frederick Isasi, executive director of the consumer health group FamiliesUSA, said that the Court's decision to uphold the ACA "will continue to ensure tens of millions of families have real, meaningful health insurance that provides them access to critical health care services and protects their financial security."

Isasi tells Verywell that examples of those protections include tax credits that help nine million people afford coverage and allow tens of millions of people with preexisting conditions to buy health insurance and not be charged more money based on their health

"The decision [also] assures…benefits like coverage for prescription drugs, maternity care, and mental health care," says Isai.

What Does the ACA Provide?

The ACA, which was passed into law in 2010 and enacted in 2014, has three main features: 

  • Subsidies that lower health insurance costs for households with incomes between 100% and 400% of the federal poverty level (FPL)  
  • Expansion of the Medicaid program to cover all adults with an income below 138% of the FPL in states that have chosen to do so. 
  • Innovative medical care delivery programs—such as methods for some faster drug and device approvals—to help lower the cost of health care. 

Challenging the ACA—Past and Future

The most recent ACA Supreme Court case was the third unsuccessful challenge to the Health Law to be brought before the High Court since the act was passed in 2010. 

New challenges to the law could be brought before the High Court since the decision by the Court was not on whether the law was constitutional, but rather, whether those bringing the suit had the right to do so.

The majority opinion of the Court was that those challenging the law did not have that right to do so because they had not been injured by the law. 

Will the ACA Be Challenged Again?

Timothy Jost, an expert on the ACA and Emeritus Professor at the Washington and Lee University School of Law, explained in a blog post for the Commonwealth Fund that while it's possible that more challenges will arise in the future, "given the Court’s decisive rejection of the case by a strong majority, the increasing public support for the ACA, the millions of people who enjoy the benefits of the law, and the absence of an active political effort to repeal it, the law should be secure for the foreseeable future.”

However, Jost added that specific provisions could be challenged, such as coverage of preventive services and whether faith-based employers must cover contraception. The outcome might rest in how the Supreme Court handles states that try to challenge the law from here on out.

According to Jost, "in the future, federal courts may be less willing to adjudicate essentially political disagreements between states and the federal government regarding federal law.” 

Many health policy experts anticipate that the most recent challenge will be the last. Andy DiAntonio, director of communications for advocacy group National Health Law Program (NHeLP) said in a statement issued after the ruling, that "we are hopeful that this was the last attempt to overturn the law that has provided access to care for millions of individuals and families."

Strengthening the ACA

Leana Wen, MD, MPH, a former health commissioner of Baltimore, an emergency physician, and a visiting professor of health policy and management at the George Washington University’s Milken School of Public Health tells Verywell that she “hopes the Biden administration can now put its efforts to expanding health insurance access, making care more affordable, and going upstream to focus on preventing illness in the first place,” 

Mara Youdelman, managing attorney for NHeLP’s Washington, D.C. office tells Verywell that turning the page on court cases and strengthening the law is critical.

“We have the opportunity to build on the ACA’s successes and strengthen it to make health care more affordable and accessible," says Youdelman.

COVID Proved the ACA's Importance

The ACA’s critical role was underscored during the COVID-19 pandemic. As people lost their jobs, many also lost the health insurance that was sponsored by their employers.

The impact of the ACA is supported by the data. In early June, a report released by the Department of Health and Human Services showed that:

  • A record 31 million Americans have health coverage through the ACA
  • The ACA has resulted in reductions in uninsurance rates in every state in the country 
  • The number of people enrolled in Medicaid (which was expanded in many states by the ACA) has reached record highs

Health policy experts look forward to an even more robust ACA. For example, Youdelman says that we need to ensure that “those living in states that have not expanded Medicaid are not left behind."

Experts say it's important to take the lessons learned from COVID with us into the future. "As COVID has laid bare, we need to find a solution to the 'coverage gap' quickly," says Youdelman. "We also need to provide equitable funding to Puerto Rico and the territories and address the maternal mortality crisis. Congress needs to act quickly and ensure everyone in the U.S. has access to affordable, accessible, culturally and linguistically competent health care.”

By Fran Kritz
Kritz is a healthcare reporter with a focus on health policy. She is a former staff writer for Forbes Magazine and U.S. News and World Report.