Supreme Court dismisses Obamacare challenge, state advocates praise ruling

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WASHINGTON (AP/WTVQ) — The Supreme Court has dismissed a challenge to the Obama era health care law, preserving insurance coverage for millions of Americans.

Kentucky supporters, including Gov. Andy Beshear, of the so-called Obamacare praised the decision and the positive impact the law has had on state residents.

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The justices, by a 7-2 vote, left the entire law intact Thursday in ruling that Texas, other Republican-led states and two individuals had no right to bring their lawsuit in federal court. The Biden administration says 31 million people have health insurance because of the law popularly known as “Obamacare.”

The law’s major provisions include protections for people with pre-existing health conditions, a range of no-cost preventive services and the expansion of the Medicaid program that insures lower-income people, including those who work in jobs that don’t pay much or provide health insurance.

Also left in place is the law’s now-toothless requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero.

The elimination of the penalty had become the hook that Texas and other Republican-led states, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law should fall, too.

And with a more conservative Supreme Court that includes three Trump appointees, opponents of Obamacare hoped a majority of the justices would finally kill off the law they have been fighting against for more than a decade.

But the third major attack on the law at the Supreme Court ended the way the first two did, with a majority of the court rebuffing efforts to gut the law or get rid of it altogether.

Trump’s three appointees to the Supreme Court — Justices Amy Coney Barrett, Neil Gorsuch and Brett Kavanaugh — split their votes. Kavanaugh and Barrett joined the majority. Gorsuch was in dissent, signing on to an opinion from Justice Samuel Alito.

Justice Stephen Breyer wrote for the court that the states and people who filed a federal lawsuit “have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.”

In dissent, Alito wrote, “Today’s decision 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, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue.” Alito was a dissenter in the two earlier cases, as well.

Because it dismissed the case for the plaintiff’s lack of legal standing — the ability to sue — the court didn’t actually rule on whether the individual mandate is unconstitutional now that there is no penalty for forgoing insurance. Lower courts had struck down the mandate, in rulings that were wiped away by the Supreme Court decision.

With the latest ruling, the ACA is “here to stay for the foreseeable future,” said Larry Levitt, an executive vice president for the non-profit Kaiser Family Foundation, which studies health care.

“Democrats are in charge and they have made reinvigorating and building on the ACA a key priority,” Levitt said. “Republicans don’t seem to have much enthusiasm for continuing to try to overturn the law.”

Republicans pressed their argument to invalidate the whole law even though congressional efforts to rip out the entire law “root and branch,” in Senate GOP Leader Mitch McConnell’s words, have failed. The closest they came was in July 2017 when Arizona Sen. John McCain, who died the following year, delivered a dramatic thumbs-down vote to a repeal effort by fellow Republicans.

Chief Justice John Roberts said during arguments in November that it seemed the law’s foes were asking the court to do work best left to the political branches of government.

The court’s decision preserves benefits that became part of the fabric of the nation’s health care system.

Polls show that the 2010 health care law grew in popularity as it endured the heaviest assault. In December 2016, just before Obama left office and Trump swept in calling the ACA a “disaster,” 46% of Americans had an unfavorable view of the law, while 43% approved, according to the Kaiser Family Foundation tracking poll. Those ratings flipped and by February of this year 54% had a favorable view, while disapproval had fallen to 39% in the same ongoing poll.

As the state’s attorney general prior to being elected governor, Beshear first intervened to join the case and defend the ACA in April 2018. In 2020, the governor joined California Attorney General Xavier Becerra to co-lead the appeal to the U.S. Supreme Court.

“I am so honored to lead Kentucky’s efforts to preserve access to affordable health care for nearly 1.8 million Kentuckians – and 133 million Americans, including 17 million children – with pre-existing medical conditions, like cancer and pregnancy, and chronic medical conditions, like heart disease, diabetes and asthma,” Beshear said. “Today is a great day for our Kentucky families and our health care systems. Now those with pre-existing conditions don’t have to worry about being denied coverage; our women and seniors won’t be forced to pay more; and our health care systems will remain strong and ready to care of all our Kentucky families.”

Beshear said there are at least 10 ways Kentuckians would have been harmed if the case was not overturned, including: expanded Medicaid would have been eliminated; children under the age of 26 would not have been able to remain on their parents’ insurance; seniors would have had to pay more for prescription drugs; and guaranteed pregnancy coverage would have been eliminated. There were also ramifications in the fight against the opioid epidemic and protection from lifetime insurance limits.

Kentucky has reduced its uninsured rate by more than half, with 683,392 Kentucky residents gaining access to health care coverage because of the Affordable Care Act, according to the U.S. Department of Health & Human Services. The commonwealth’s uninsured rate fell from 14.3 percent in 2013 to 6.4 percent as of 2019.

The Texas v. U.S. case began in late February 2018, when the plaintiffs, two individuals along with 18 states led by Texas, filed a lawsuit challenging one provision of the ACA: the requirement that individuals maintain health insurance or face a zero-dollar tax. The plaintiffs argued that this change made the minimum coverage provision unconstitutional and that the rest of the ACA could not be “severed” from that one provision, so the entire act must be struck down. Gov. Beshear and the coalition of states moved to intervene in the case on April 9, 2018.

On December 14, 2018, a Northern District of Texas judge issued his decision agreeing with the plaintiffs.

In response, the coalition of attorneys general filed a motion to stay the effect of that decision and to expedite resolution of the case. The district court granted that motion on December 30, 2018. On January 3, 2019, the coalition of attorneys general continued their legal defense and appealed to the Fifth Circuit Court of Appeals. The Fifth Circuit upheld the district court’s decision on December 18, 2019, and Beshear and the coalition of states sought the Supreme Court’s review on January 3, 2020.

SCOTUS heard oral arguments on the California vs. Texas case on November 10, 2020. Healthcare advocates and ACA proponents have been anxiously waiting for a ruling to come down ever since – and justly so. The coverage of millions of Americans depends on the ACA.

“The Affordable Care Act will remain the law of the land! Today’s U.S. Supreme Court opinion upholding the ACA in its entirety is both a relief and a breath of renewed energy in the fight for affordable and accessible healthcare for every Kentuckian,” said Emily Beauregard, Executive Director of Kentucky Voices for Health. “Instead of trying to take healthcare away from people, it’s time for our policymakers to build on the ACA’s successes and reimagine a healthcare system that is truly equitable so that every Kentuckian can thrive. We should start by permanently lowering premiums and reducing deductibles, copayments, and prescription drug costs for everyone.

The ACA has changed the lives of millions of Kentuckian for the better, allowing individuals to live more fulfilling and healthier lives. Thanks to the ACA:

  • More than 490,000 Kentucky adults and 52,000 children have gained coverage.
  • 1.8 million Kentuckians, and 135 million individuals nationwide, with preexisting conditions cannot be denied healthcare coverage or charged more for their coverage.
  • Kentucky receives a minimum of $4.3 billion dollars in federal funding each year.
  • Kentucky hospitals receive a minimum of $1.7 billion dollars in revenue annually.
  • 2.3 million adult children under the age of 26 will be able to stay on their parents’ insurance nationwide.
  • The Medicare “donut hole” is closed for nearly 12 million senior Americans.
  • More than 80,000 Kentuckians and over 9 million Americans receive premium subsidies and discounts on out of pocket costs from the Marketplace.

“Perhaps most critically, the ACA is the only law that protects people with pre-existing health conditions like cancer, diabetes, or a behavioral health disorder from being denied coverage by insurance companies or forced to pay higher premiums,” said Dr. Sheila Schuster, Board Chair of Kentucky Voices for Health. “With COVID-19 now also considered a pre-existing condition—and the spread of infectious variants on the rise—we need the ACA more than ever to safeguard ourselves, our families and our neighbors against health catastrophes and financial ruin.”

Because of the ACA, insurers are also banned from:

  • Discriminating against women and older adults by charging them more for their health insurance;
  • Imposing annual lifetime caps on coverage;
  • Denying essential health benefits, like prescription drugs and maternity care.

“There is still work to be done in the fight for more affordable, accessible, and high quality healthcare for all, but thanks to the ACA, Kentucky’s uninsured rate is less than 8% and we have new options to get even more people covered,” said Cara Stewart, Director of Policy Advocacy for Kentucky Voices for Health. “There’s no better time to shop on healthcare.gov. Four out of five Kentuckians can find a healthcare plan for $10 or less per month after premium tax credits, and more than half will be able to find a Silver plan with a $0 premium.”

The current Special Enrollment Period (SEP) ends on August 15. Kentuckians should explore Marketplace options and get affordable healthcare today at healthcare.gov. With the support of kynectors, Kentuckians can find free, local help to help them through the enrollment process by visiting kynect.ky.gov or calling 855.306.8959.