The U.S. Supreme Court today issued a 7-2 ruling that keeps the Affordable Care Act in place.
The court held that Texas, other states that oppose the Affordable Care Act, and two self-employed men in Texas have no standing to challenge the constitutionality of the ACA individual coverage ownership mandate, or to use mandate constitutionality challenge to overturn the entire health law.
What the Ruling Means
Today's ruling means that health insurers, pricing actuaries, public health insurance exchange programs, and agents and brokers can continue to plan for the fall health coverage selling season under the current rules.
If the court had sided with Texas' coalition, the result could have been anything from a stay that could have kept the ACA in place for years, to a narrow ruling that would have simply struck down the individual mandate, to an immediate elimination of laws that shape everything from Medicaid nursing home benefits to Medicare Part D prescription drug benefits.
Breyer's Opinion
Justice Stephen Breyer wrote the opinion for the majority.
Breyer reasoned in the opinion that that the individual mandate cannot hurt the two individual plaintiffs, because Congress set the penalty for the ACA's "minimum essential coverage" provision — the individual mandate — at zero when it passed the Tax Cuts and Jobs Act of 2017.
The state plaintiffs did not succeed at showing how the zeroed-out penalty would cause residents to act in ways that would increase costs for Texas or the other state plaintiffs, Breyer added.
The state plaintiffs made other points about how the ACA has hurt them, but Breyer said none of those concerns related directly to the individual mandate.
"We conclude that the plaintiffs in this case failed to show a concrete, particularized injury fairly traceable to the defendants' conduct in enforcing the specific statutory provision they attack as unconstitutional,' Breyer wrote. "They have failed to show that they have standing to attack as unconstitutional the act's minimum essential coverage provision."
The court reversed a federal district court ruling and a 5th U.S. Circuit Court of Appeals ruling that sided with the plaintiffs.
The Other Justices
Chief Justice John Roberts and Justices Sonia Sotomayor, Elena Kagan, Brett Kavanaugh, Amy Coney Barrett joined in Breyer's opinion.
Justice Clarence Thomas joined in Breyer's opinion and also filed a concurring opinion.
Justices Samuel A. Alito Jr. and Neil Gorsuch opposed the ruling. Alito wrote a dissenting opinion, and Gorsuch joined in Alito's opinion.
Thomas wrote in his concurring opinion that the ACA has a dubious history at the Supreme Court, but that the court must assess the current suit on its own terms.
"The plaintiffs failed to demonstrate that the harm they suffered is traceable to unlawful conduct," Thomas wrote. "Although this court has erred twice before in cases involving the Affordable Care Act, it does not err today."
Alito argued that the plaintiffs in the case clearly have suffered harm from the ACA and that the majority applied standing rules incorrectly.
Standing v. Severability
Justices hinted that questions about standing could be central to the outcome of California v. Texas in November 2020, when they heard oral arguments about the case.
