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High court quashes challenge from states including Arizona, to Affordable Care Act

Former President Barack Obama’s signature health care law survived its latest conservative-led challenge in a 7-2 decision Thursday from the U.S. Supreme Court.

The case here took aim at a provision of the Patient Protection and Affordable Care Act that requires most Americans to obtain minimum essential health insurance coverage. Originally the so-called individual mandate imposed a monetary penalty on those who who failed to get required coverage, but lawmakers zeroed out the penalty during former President Donald Trump’s first year in office.

For the conservative states like Texas that sued in 2018, this change made the minimum essential coverage provision unconstitutional. They prevailed in 2018 with a federal judge ruling that the entirety of the Affordable Care Act must fall without the individual-mandate penalty. Though the Fifth Circuit affirmed in part — agreeing that the individual mandate was unconstitutional without the tax — it did not strike down the full law.

The Supreme Court heard oral arguments last year and reversed that decision Thursday, saying none of the states had standing to sue in the first place.

“With the penalty zeroed out, the IRS can no longer seek a penalty from those who fail to comply,” Justice Stephen Breyer wrote for the majority. “Because of this, there is no possible Government action that is causally connected to the plaintiffs’ injury — the costs of purchasing health insurance. Or to put the matter conversely, that injury is not ‘fairly traceable’ to any ‘allegedly unlawful conduct’ of which the plaintiffs complain. They have not pointed to any way in which the defendants, the commissioner of Internal
Revenue and the secretary of Health and Human Services, will act to enforce §5000A(a). They have not shown how any other federal employees could do so either. In a word, they have not shown that any kind of Government action or conduct has caused or will cause the injury they attribute to §5000A(a).”

Thursday’s ruling comes nearly a decade after the high court ruled that the individual mandate built into the Affordable Care Act was not akin to an unconstitutional tax, as charged by opponents at the time. The court upheld the law again in 2015, ruling this time on a component of the law that offered nationwide tax subsidies.

Justice Samuel Alito wrote in dissent Thursday how “in all three episodes … the court has pulled off an improbable rescue.”

Questioning how the majority could find that none of the 18 states behind the latest challenge have standing, Alito pointed to the law’s “many burdensome obligations on states in their capacity as employers.”

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“Even $1 in harms enough to support standing,” he balked. “Yet no state has standing?”

As Breyer saw it, however, the injury claimed by Texas et al. failed to be “real and substantial” — a bare minimum requirement for any declaratory judgment.

“What is relief? The plaintiffs did not obtain damages. Nor as we just said, did the plaintiffs obtain an injunction in respect to the provision they attack as unconstitutional. But more than that: How could they have sought any such injunction? The provision is unenforceable. There is no one, and nothing, to enjoin,” Breyer wrote.

To award injunctive relief in this case, Breyer said, “could amount to no more than a declaration that the statutory provision they attack is unconstitutional, i.e., a declaratory judgment.”

“But once again, that is the very kind of relief that cannot alone supply jurisdiction otherwise absent,” the ruling continues.

In support of the states’ standing, Alito wrote that even a “casual connection between the injury and the conduct complained of” would be sufficient.

Moving on to the merits, Alito asserted, that with “tax” set at $0, the coverage mandate cannot be sustained under the taxing power.

“As a result, it is clearly unconstitutional, and to the extent that the provisions of the ACA that burden the states are inextricably linked to the individual mandate, they too are unenforceable,” he said.

Roughly 23 million Americans are covered by the Affordable Care Act, which President Joe Biden is actively working to expand at present. Under the administration’s pandemic relief package, subsidies were increased for private health insurers.

In a statement Thursday, President Joe Biden called the latest endorsement of the law a welcome sign “in the midst of a once-in-a-century pandemic.”

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“I look forward to working with the Congress to build on this law so that the American people will continue to have access to quality and affordable health care,” Biden said.

Despite grousing by the lion’s share of Republicans in Congress, the law is also hugely popular with the American public. Kaiser Family Foundation tracked a 53% favorability rating for the Affordable Care Act in May — a 10-point increase from four years ago. The survey is one that the foundation updates regularly.

David Vivero, CEO of Amino, a group that helps workers find affordable health care options on their employer’s plan, lauded the high court’s decision as proof that the federal health care law is useful to millions of Americans.

“The changes this legislation introduced 11 years ago, such as protections for patients with preexisting conditions and essential health benefits, are integral to our healthcare experience today. Whether we get health insurance through a marketplace or through our employer, we have better coverage options as a result of the ACA,” Vivero said.

Among the law’s most popular features is its inclusion of young adults and its provision of free birth control to the insured. Regular cancer screenings are also built in.

Justice Clarence Thomas joined the majority Thursday, and in a concurring opinion underscored what he called the “fundamental problem” with the case by Texas.

“They have not identified any unlawful action that has injured them,” Thomas wrote. “Today’s result is thus not the consequence of the court once again rescuing the act but rather of us adjudicating the particular claims the plaintiff’s chose to bring.”

Having been part of the dissenting group the previous two times that the Supreme Court upheld the law, Thomas praised Alito for his account of the “Affordable Care Act trilogy.”

“This court has gone to great lengths to rescue the act from its own text … So have the act’s defenders, who argued in first instance that the individual coverage mandate is the act’s linchpin, yet now, in an about-face, contend that it is just a throwaway sentence. But, whatever the act’s dubious history in this court, we must assess the current suit on its own terms,” Thomas wrote.

Justice Neil Gorsuch alone joined Alito’s dissent, with Chief Justice John Roberts joining the majority opinion alongside Justices Sonia Sotomayor, Elena Kagan, Brett Kavanaugh and Amy Coney Barrett.

This story originally appeared on The Conversation.

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LaDawna Howard | CC BY 2.0

A rally in front of the U.S. Supreme Court in Washington, D.C. on March 27, 2012, in support of the Affordable Care Act, still known as 'Obamacare'.