WASHINGTON – The Affordable Care Act Thursday survived a third major challenge that the Supreme Court, on a 7-2 vote, rejected Republicans’ latest effort to kill the healthcare law.

The legislation, President Barack Obama’s defining national heritage, has been the subject of relentless Republican hostility. But congressional attempts to repeal it have failed, as have two previous Supreme Court challenges, in 2012 and 2015. Over the years, the law has grown in popularity and woven into the fabric of the health care system. .

On Thursday, in what Justice Samuel A. Alito Jr. called, in dissent, “the third installment of our epic Affordable Care Act trilogy,” the Supreme Court again upheld the law. Its future now seems secure and its power as a political stake for Republicans reduced.

The margin of victory was wider than in previous cases, with six members of the court joining the modest and technical majority opinion of Judge Stephen G. Breyer, one who said only that the 18 Republican-led states and the two people who brought the case had not suffered the kind of direct prejudice that gave them standing.

Chief Justice John G. Roberts Jr., who cast the decisive vote to save the law in 2012, was in the majority. The same was true of Justice Clarence Thomas, who had expressed his dissent in previous decisions.

“Whatever the questionable history of the act in this court,” Judge Thomas wrote in a concurring opinion, “we must assess the pending lawsuit on its own terms. And, here there is a fundamental problem with the arguments put forward by the plaintiffs to attack the act – they did not identify any illegal actions that hurt them.

Justices Sonia Sotomayor, Elena Kagan, Brett M. Kavanaugh and Amy Coney Barrett also joined Judge Breyer’s majority opinion. In Judge Barrett’s confirmation hearings last year, Democrats described her as a serious threat to healthcare law.

The court did not address the larger questions of the case: whether most of the law could be sustained without a provision that initially required most Americans to purchase insurance or pay a penalty.

“This decision reaffirms what we have long known to be true: The Affordable Care Act is here to stay,” Mr Obama said on Twitter.

In the 11 years since Mr. Obama enacted the legislation, Republicans have attacked the Affordable Care Act as a step towards socialized medicine, government intrusion into health care decisions and a costly mess.

They have challenged it on various fronts in the courts and have made calls for its repeal a staple of their campaigns. But some of its provisions, like coverage for pre-existing conditions and adult children up to age 26, have proven popular across parties. Even when they controlled the Senate, House, and White House, Republicans failed to rally their voices to repeal the law – and despite President Donald J. Trump’s promises to come up with a better alternative, he didn’t. has never produced a detailed proposal.

As healthcare remains a potent political issue – and the Affordable Care Act has flaws Democrats have recognized – the latest court ruling suggests Republicans’ chances of winning a legal battle to kill him are now very small.

“With millions of people depending on the Affordable Care Act for coverage, this remains, as always, a BFD” President Biden said on Twitter after the ruling, alluding to his obscene comment to Mr. Obama on March 2010, the bill was enacted that the legislation was a big deal. Mr Biden said he now wants to build on the legislation by taking a series of steps to expand access to health care.

Republicans criticized the move, but suggested the battle will now focus on political struggle in Congress.

“The failure of the Obamacare system will falter as a result of this decision,” said Senator John Barrasso, Republican of Wyoming.

“The health care of all Americans has been damaged by Obamacare,” he said. “Republicans remain focused on the need to make health care more affordable for families in Wyoming and the country. Democrats continue to pour money into Obamacare instead of fixing the many issues facing patients and healthcare providers. “

The challengers in the case have sought to take advantage of the 2012 ruling, in which Chief Justice Roberts upheld a central provision of the law, his individual tenure requiring most Americans to purchase health insurance or pay a fine. , claiming that she was authorized by the power of Congress to collect taxes.

They argued that the warrant became unconstitutional after Congress in 2017 removed the penalty for failing to obtain coverage because it could no longer be justified as a tax. They went on to say that this meant the rest of the law had to fall as well.

The challenge was largely successful in the lower courts. A Texas federal judge ruled that the entire law was invalid, but he postponed the effects of his ruling until the case can be appealed. In 2019, the United States Court of Appeals for the Fifth Circuit in New Orleans agreed the warrant was unconstitutional but declined to rule on the fate of the rest of the health law, asking the lower court to reconsider the matter in more detail. .

Judge Breyer did not address most of the arguments that formed the basis of these decisions, focusing instead on whether complainants had the right to sue.

Both people, he wrote, suffered no prejudice from a toothless disposition that in fact only pushed them into purchasing health insurance. Likewise, he wrote, states have not suffered injuries directly related to the elimination of punishment that was part of the individual mandate.

States argued that the revised mandate would encourage more people to take advantage of state-sponsored insurance programs. Breyer J. rejected this theory.

“State plaintiffs have failed to show,” he wrote, “that the challenged essential minimum coverage provision, without any prospect of punishment, will harm them by causing more people to take action. enroll in these programs ”.

“Neither logic nor intuition suggests that the presence of the essential minimum coverage requirement would lead an individual to enroll in one of those programs that their absence would lead them to ignore,” Judge Breyer wrote. “A penalty could have led some paralyzed individuals to register. But without penalty, what incentive could the provision offer? “

In vigorous dissent, Judge Alito, joined by Judge Neil M. Gorsuch, said the third installment of the court’s affordable care trilogy “followed the same pattern as installments 1 and 2.”

“In all three episodes, with the Affordable Care Act facing a serious threat,” he wrote, “the court managed an unlikely rescue. “

Justice Alito wrote that the court has consistently found states to have standing to challenge federal initiatives. “Just recently,” he wrote, “New York and some other states were allowed to challenge the inclusion of a citizenship question in the 2020 census, even though any effect on them depended on a string speculative events. “

He said there were “new questions” on whether individual complainants could proceed. But “States have quality for simple and meritorious reasons,” he wrote. “The court’s decision to the contrary is based on a fundamental distortion of our continuing jurisprudence.”

Unlike the majority, Judge Alito then turned to the broader issues of the case, California v. Texas, No. 19-840, claiming that the mandate was now unconstitutional and could not be separated from much of the rest of the law.

Had Judge Alito’s point of view prevailed, the country’s healthcare system would have experienced an earthquake.

Removal of the Affordable Care Act would have widened the number of uninsured people in the United States by about 21 million people, an increase of almost 70%, according to recent estimates of the Urban Institute.

The biggest loss of coverage would have been among low-income adults who became eligible for Medicaid under the law after most states expanded the program to include them. But millions of Americans have also reportedly lost their private insurance, including young adults the law allowed to stay on their parents’ plans until the age of 26 and families whose incomes were small enough to have. entitled to grants that help them pay their monthly premiums.

A ruling against the law would also have doomed its protections for Americans with past or current health problems. The protections prohibit insurers from denying them coverage or charging them more for pre-existing conditions.

“Today’s decision means that all Americans continue to have the right to access affordable care without discrimination,” said Xavier Becerra, Secretary of Health and Human Services, who in his former California attorney general’s post, helped defend the law in Thursday’s case. .

Mr Biden has said he wants to build on the Affordable Care Act by taking measures such as expanding health insurance subsidies, and some Democrats are pushing for bigger proposals such as the extending Medicare coverage to more people.

Republicans suggested Thursday that they would now focus less on researching the repeal of the law and more on debating in Congress and the election campaign for 2022 on how to tackle issues such as affordability. Health Insurance.

“While the Supreme Court today ruled that states lack standing to challenge the warrant, the ruling does not change the fact that Obamacare broke promises and harms hard-working American families.” , the top three House Republicans, Representatives Kevin McCarthy, Steve Scalise and Elise Stefanik, said in a statement. “Now Congress must work together to improve American health care.”


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