November 23, 2020 by Southern Maine Workers Center

What’s Going On with the Affordable Care Act?

This is the first in a series of brief articles by members of the Southern Maine Workers Center’s Health Care is a Human Right Committee covering the current challenge to the Affordable Care Act (ACA), the ACA in the broader context of American health care history, how successful or not the ACA has been to provide healthcare for working people, and what the path to Universal Healthcare could look like. 

The Affordable Care Act (ACA), commonly known as Obamacare, is back in the Supreme Court this year and the court heard oral arguments last Tuesday, November 10. The case, California V Texas, is challenging the constitutionality of the law’s “individual mandate” that requires everyone purchase health insurance or pay a penalty. The case will likely be decided in June. In this short article, we will explore the legal challenge and it’s potential outcome and consequences. 

The ACA became law in March, 2010 and immediately faced legal opposition. It first came before the Supreme Court in the 2012 landmark case, National Federation of Independent Businesses v Sebelius. The case challenged the constitutionality of the individual mandate, Medicaid expansion, and other provisions of the law. In a 5-4 decision the court upheld the constitutionality of the individual mandate as within Congress’s power to tax and the ACA passed its first major legal hurdle.

A lot has changed since 2012. First, President Trump’s 2017 tax reform bill reduced the individual mandate penalty to $0 in 2019. So while the individual mandate remains a provision of the ACA, there is currently no penalty. Second, the makeup of the court has changed. President Trump has appointed Neil Gorsuch, Brett Kavanuagh, and Amy Comy Barrett to the Supreme Court creating a 6-3 conservative majority. What does this mean for the current legal challenge?

California V Texas again challenges the individual mandate provision. The challenge is brought by Texas and the Trump administration and essentially argues that since the individual mandate is now $0 and raises no revenue it is no longer a tax and therefore unconstitutional. They argue that the mandate provision is so intertwined with the law that the ACA must be struck down if the mandate is ruled unconstitutional. Ultimately this is the crux of the case: if the individual mandate is judged unconstitutional, would the whole ACA be struck down? What would that mean this mean for US healthcare?

According the Brookings Institute, “if the Court strikes down the ACA in its entirety, 20 million people would lose health insurance, a variety of protections for people with pre-existing conditions would be eliminated, and an extensive set of policies affecting Medicare, Medicaid, prescriptions drugs, and other parts of the healthcare system would be reversed.” By most estimations, the results would be chaotic and, in the midst of a pandemic, deadly. Major actors in the healthcare industry are lobbying the Supreme Court to uphold the law. Conservative justices Roberts and Kavanuagh have both stated publicly that they prefer to sever unconstitutional provisions from statutes rather than take down entire laws. 

The future of the ACA is up to the Supreme Court and we will likely know their decision by June. The future of healthcare is up to us, the people. As we will explore in this series, the ACA does not guarantee universal health care, it mandates universal health insurance. And that insurance isn’t necessarily affordable. Regardless of what the Supreme Court decides in June, we are organizing for justice and equity in our healthcare systems. 

Stay tuned for our next installment, the ACA in the broader context of American history, and sign up below to get involved with Healthcare is a Human Right Committee’s work for universal healthcare.