WASHINGTON -- The Supreme Court on Monday agreed to hear a case challenging the Affordable Care Act (ACA), leaving most healthcare groups pleased, although some said they would like to see the high court's review expedited.
"While today's Supreme Court decision to review the challenge to the ACA brings us one step closer to the resolution patients need, these critical coverage gains will remain in unnecessary limbo without expedited review," Rick Pollack, president and CEO of the American Hospital Association, said in a statement. "We strongly urge a prompt decision in favor of the ACA and its protections for patients with pre-existing conditions, expansion of the Medicaid program, creation of new and innovative models of care, and many other critical benefits. America's hospitals and health systems and the patients we serve are ready to put this legal fight behind us – for good."
"We applaud the Supreme Court's decision to grant certiorari ... which will remove the continued legal uncertainty that undermines the stability of coverage for nearly 300 million Americans," Matt Eyles, president and CEO of America's Health Insurance Plans, said in a statement. "We are confident that the Supreme Court will agree that the district court's original decision to invalidate the entire ACA was misguided and wrong, and that zeroing out the mandate was never intended to wreak havoc across the entire American healthcare system."
The case, formerly called Texas v. Azar or Texas v. U.S. and California v. Texas, was filed in early 2018 by attorneys general in Texas and 19 other Republican-controlled states. It revolves around a provision in the ACA known as the "individual mandate," which required people to buy health insurance or pay a financial penalty. Congress eliminated that penalty in 2017 as part of the Tax Cuts and Jobs Act.
In December 2018, Judge Reed O'Connor of the U.S. District Court for the Northern District of Texas sided with the plaintiffs, who argued that the ACA became unconstitutional after Congress scrapped the individual mandate penalty. Congress had unequivocally stated time and again that the mandate was "essential" and "inseverable" from the rest of the ACA's provisions, O'Connor explained, but rewriting the law without its "essential" feature was beyond the power of his court.
The decision was appealed, and in December, a federal appeals court agreed that the individual mandate was unconstitutional but told the district judge in the case to look again at whether other parts of the law can still stand. California Attorney General Xavier Becerra , and the court then agreed Monday to take up the case.
For their part, California and other critics of the case argue that because Congress eliminated just the individual mandate, that implies that Congress considered the rest of the law severable from it. "In petitioners' view, even if the minimum coverage provision is unconstitutional, the balance of the ACA must remain in place," .
Supporters of the law also argue that if the ACA were entirely struck down, millions of people would be left without health insurance coverage and without the law's protections, including its ban on discrimination against patients with pre-existing conditions and its requirement that insurers must allow children up to age 26 to remain on their parents' health insurance policies.
"Without the protections of the ACA, patients, survivors, and their families could once again be denied coverage or charged so much that they would have to go without the lifesaving care that they need," the American Cancer Society, the American Diabetes Association, the American Heart Association, the American Lung Association, and more than a dozen other groups said in a joint statement. "Americans need to know what coverage options will be available as soon as possible and the court's decision to take up the case this term is critical to ensuring individuals can make informed choices about their health care needs. On behalf of all the patients we represent, we urge the Supreme Court to uphold the law and provide the clarity and certainty people and the health care system need."
One question the court will have to decide is "standing" -- that is, whether the attorneys general actually have a right to sue, , a senior correspondent at Vox. "As a general rule, no one is allowed to challenge a law in federal court unless they can show they were injured by that law. Because the zeroed-out mandate does nothing, it's highly doubtful that anyone is allowed to challenge it." (On the other hand, that argument was made and rejected by the district and appeals court judges.)
"Assuming that President Trump does not get to replace any of the current justices, the Supreme Court is unlikely to agree with the lower-court judges who ruled against Obamacare," Millhiser predicted. "Chief Justice John Roberts twice broke with his conservative colleagues in lawsuits attacking Obamacare, and Roberts is especially likely to reject the Texas plaintiffs' legal arguments. But, so long as this lawsuit exists, it remains a threat to Obamacare. And there is no guarantee that the court's membership will not change."
As for a timeline on when the court is likely to hear the case, "if this follows traditional patterns, the arguments will be presented in the fall of 2020 with a decision at the end of the term in mid-2021," , former administrator of the Centers for Medicare & Medicaid Services under President Obama. Slavitt added, "If the Court did not hear the case now, it would have been delayed for at least a year and sent back to a district court. Trump asked for it to be delayed. He didn't want this covered during election season and he wanted the opportunity to appoint more justices" to the Supreme Court first.