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The Supreme Court last week upheld the Affordable Care Act, knocking down the latest attempt by conservatives to dismantle former President Barack Obama’s signature legislative achievement.
In a 7-2 decision, the court ruled that Texas and other Republican-led states calling for the ACA to be overturned lacked standing to challenge the law because they couldn’t prove it caused them measurable harm. The justices did not address the underlying argument behind the states’ case, centered on the claim that the law’s “individual mandate” became unconstitutional when Congress reduced the penalty for not having health insurance to $0 in 2019.
Ever since it was enacted in 2010, the law commonly known as Obamacare has faced constant GOP efforts to eliminate it. There have been more than 2,000 attempts to have the law invalidated in the courts. Last week’s ruling marks the third time those challenges have advanced all the way to the Supreme Court, only to be rejected by a majority of justices. Republicans in Congress have tried to repeal the ACA more than 70 times. Former President Donald Trump vowed to “repeal and replace” the ACA and came within a single vote in the Senate of fulfilling that promise in 2017.
Why there’s debate
Democrats celebrated the court’s decision, arguing that it marked a decisive end to more than a decade of GOP attempts to repeal Obamacare. “This ruling reaffirms what we have long known to be true: the Affordable Care Act is here to stay,” Obama tweeted last week. Many legal experts say the fact that two of Trump’s three appointees — Justices Brett Kavanaugh and Amy Coney Barrett — voted to uphold the ACA shows that future efforts to convince the court to sink the legislation are doomed to fail.
Even some on the right have argued that it may be time for conservatives to move on from the Obamacare fight. “With the Affordable Care Act just constantly woven deeper and deeper into the system, it’s eventually going to be pretty hard to unravel from the system,” Sen. Roy Blunt, R-Mo., said. Polls show that the ACA has become increasingly popular with the public in recent years, which could stop Republicans in Congress from trying to repeal it even if they regain legislative control in the next few years.
Others contend that attempts to get rid of Obamacare are far from over. Some state-level Republican attorneys general have vowed to continue filing legal challenges to the ACA. It’s possible, some argue, that the underlying argument of the most recent case could ultimately be convincing to a majority of justices if a case involving plaintiffs with stronger standing is filed. There are also a number of active cases that could threaten key elements of the ACA — such as the requirement that health plans cover birth control — without eliminating the law in its entirety.
Health and Human Services Secretary Xavier Becerra told reporters the Biden administration had been waiting for this case to be resolved before moving forward with plans to bolster the ACA. “We’ve had to hold back,” he said. “Now we can talk about how we can build on it.”
A long list of proposed health care reforms has been put forward by Democrats, including creating a public option, changing how Medicare negotiates prescription drug prices and lowering the Medicare eligibility age from 65 to 60. The prospects that any or all of those plans can get through Congress are unclear.
Obamacare is safe
Republican attempts to undermine the ACA have only made it stronger
“Obamacare is getting stronger every time the Republicans try to kill it.” — Elie Mystal, the Nation
The Supreme Court has shown it’s not willing to rewrite health care policy
“Health-care policy badly needs to be addressed. But that remains a task for Congress. It was never the Court’s job to do it, and it has been obvious for a decade that the Roberts Court, even with a now stronger conservative majority, intends to defer to Congress.” — Andrew C. McCarthy, National Review
The ACA has become too entrenched to be removed
“ACA has survived the initial years when it was most vulnerable. With each passing year, it will only become stronger and more cemented. Although ACA cost Obama an enormous amount of political capital and heartache, it’s become clear that he will have the last laugh. His program has become an integral part of our health care system.” — Julian Zelizer, CNN
The GOP only cares about appearing to fight the ACA, not actually dismantling it
“Having failed numerous times to kill the ACA in Congress, conservatives took it to court. Again. And even if they failed, it was always more important to be seen to fighting Obamacare, than to actually fight it. ... This campaign was optics, not policymaking.” — Jay Michaelson, Daily Beast
Republican enthusiasm for tearing down the law has dwindled
“Since no other legal challenges appear on the horizon, and even the feistiest Republicans have given up talking seriously about repeal, it seems safe to say that Obamacare we shall always have with us.” — Megan McArdle, Washington Post
Obamacare isn’t safe
Democrats celebrating the court’s latest ruling are being too optimistic
“When that next case comes, and it will, several justices indicated they are ready and willing to strike down the entire ACA. ... It is far from certain the Supreme Court will safeguard the Affordable Care Act the next time the law reaches the court’s chambers.” — Leah Litman, NBC News
Republicans aren’t going to give up their efforts to repeal the ACA
“I have no doubt that the conservative states ... will figure out another way to challenge the law. They will find a plaintiff who does have standing, and this will all start working its way through the courts again. So this is a huge, huge victory for Obamacare, but it is not the end of the story.” — Jeffrey Toobin, CNN
The court could still find the individual mandate unconstitutional down the road
“Importantly, the way the Supreme Court decided the case means that it did not rule on the merits of Obamacare itself, meaning that if another case gets to the court, it might still weigh in on that question.” — GianCarlo Canaparo, Daily Signal
The entire law may be safe, but key provisions are still under threat
“This is not the end of ACA litigation, however. Far from it. ... The ACA created a perfect storm for ongoing litigation, and ongoing litigation we will see. The difference, however, is that current and future cases will largely concern the administration and enforcement of the ACA, not its underlying architecture.” — Jonathan H. Adler, Reason
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