The Supreme Court preserved insurance coverage for millions of Americans on Thursday, dismissing the third major challenge to the national healthcare law known as “Obamacare.”
The judges, by a 7-2 votes, left the entire Affordable Care Act intact by ruling that Texas, other Republican-led states, and two individuals did not have the right to sue in federal court. The Biden administration says 31 million people have health insurance because of the law.
The main provisions of the law include protections for people with existing health problems, a range of free preventive services, the extension of the Medicaid program which guarantees low-income people and health insurance markets subsidized plans .
“The affordable care law remains the law of the land,” said President Joe Biden, welcoming the decision and calling for building on the health care law that was enacted when he was vice president.
There also remains in place the law’s now toothless requirement that people have health insurance or pay a penalty. Congress made this provision moot in 2017 when it reduced the penalty to zero.
Eliminating the penalty had become the hook that Texas and other GOP-led states, as well as the Trump administration, used to attack the law as a whole. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law should also fall.
And with a more conservative Supreme Court that includes three people appointed by Trump, opponents of Obamacare hoped that a majority of judges would finally eliminate the law they have been fighting for more than a decade.
But the third major attack on the law at the Supreme Court ended in the same way as the first two, with a majority of the court pushing back efforts to either gut the law or get rid of it altogether.
Trump’s three Supreme Court appointees – Justices Amy Coney Barrett, Neil Gorsuch and Brett Kavanaugh – have divided their voices. Kavanaugh and Barrett joined the majority. Gorsuch disagreed, agreeing with Judge Samuel Alito’s opinion.
Judge Stephen Breyer wrote for the court that states and those who brought federal complaints “have failed to show standing to challenge the law’s minimum essential cover provision as unconstitutional.”
Disagreeing, Alito wrote, “Today’s ruling 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, as the Affordable Care Act faces a serious threat, the court managed an unlikely rescue. Alito was also a dissenter in the two previous cases in 2012 and 2015.
Like Alito, Justice Clarence Thomas was dissenting in the previous two cases, but joined the majority on Thursday, writing: “Although this Court has been wrong twice in cases involving the Affordable Care Act, it does not. make no mistake today.
Because it dismissed the case for the plaintiff’s lack of legal capacity – the ability to prosecute – the court did not actually rule on whether the individual warrant is unconstitutional now that there is no penalty for waiving insurance. The lower courts had quashed the warrant, in rulings that were overturned by the Supreme Court ruling.
With the latest decision, the ACA is “here to stay for the foreseeable future,” said Larry Levitt, executive vice president of the nonprofit Kaiser Family Foundation, which studies healthcare.
“Democrats are in the driver’s seat and they have made revitalizing and strengthening the ACA a key priority,” Levitt said. “Republicans don’t seem to have much enthusiasm to keep trying to overturn the law.”
Republicans have made their case to strike down the entire law, even though Congress’ efforts to wrest the entire “root and branch” law, in the words of GOP Senate Leader Mitch McConnell, have failed. They came closest in July 2017, when Arizona Senator John McCain, who died the following year, voted in favor against an effort to repeal his fellow Republicans.
Chief Justice John Roberts said in oral argument in November that it seemed enemies of the law were asking the court to do the job best left to the political branches of government.
The court ruling preserves the benefits that are now part of the fabric of the country’s health system.
Polls show the 2010 healthcare law gained popularity as it came under the most violent onslaught. In December 2016, just before Obama stepped down and Trump called the ACA a “disaster,” 46% of Americans had an unfavorable opinion of the law, while 43% approved of it, according to the tracking poll. of the Kaiser Family Foundation. Those ratings rocked and by February of this year 54% had a favorable opinion, while disapproval had fallen to 39% in the same ongoing poll.
The health care law is currently undergoing an expansion under Biden, who sees it as the basis for moving the United States to universal coverage. Its giant COVID-19 relief bill dramatically increased subsidies for private health plans offered by ACA insurance markets, while dangling higher federal payments ahead of the dozen states who refused the Medicaid expansion of the law. About 1 million people have signed up on HealthCare.gov since Biden reopened registrations amid high levels of COVID cases earlier this year.
Most of those legally insured have it through the expansion of Medicaid or health insurance markets that offer private subsidized plans. But its most popular benefit is protection for people with pre-existing health issues. They cannot be turned down for coverage due to health issues or charged a higher premium. While people covered by employer plans already had such protections, “Obamacare” guaranteed them to people purchasing individual policies.
Another very popular benefit allowed young adults to stay in their parents’ health insurance until the age of 26. Before the law, going without medical coverage was a rite of passage for people in their twenties new to the world.
Because of the ACA, most privately insured women receive birth control free of charge. This is a covered preventive benefit at no additional cost to the patient. The same goes for routine screening for cancer and other conditions.
For Medicare beneficiaries, “Obamacare” also improved preventative care and, more importantly, closed a multi-thousand dollar prescription drug coverage gap known as the “donut hole.”
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