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WASHINGTON – The Affordable Care Act on Thursday survived its third major challenge in the Supreme Court.
A majority of seven judges ruled that the plaintiffs did not suffer the kind of direct harm that gave them the right to sue.
The court did not address the larger issues of the case: whether the bulk of the sprawling 2010 Medicare Act, President Barack Obama’s defining domestic legacy, could stand without a condition that initially required most Americans to obtain insurance or pay a fine.
In the years since the law was enacted in 2010, Republicans have worked hard to destroy it, and President Donald J. Trump has relentlessly criticized it. But attempts to overturn it have failed, as in two previous Supreme Court appeals, in 2012 and 2015. Over the years, the law has gained popularity and has been woven into the fabric of the health care system. Her future now appears secure.
Repealing the Affordable Care Act would have expanded the ranks of the uninsured in the United States by nearly 21 million people — an increase of nearly 70 percent — according to recent estimates from the Urban Institute.
The largest loss of coverage was among low-income adults who became eligible for Medicaid by law after most states expanded the program to include them. But millions of Americans would also have lost private insurance, including young adults who were allowed by law to stay in their parents’ plans until age 26 and families whose incomes were modest enough to qualify for benefits that help pay their monthly premiums.
A ruling against the law would have eliminated the protections it provides to Americans with past or current health problems — or pre-existing conditions. Protection prevents insurance companies from denying them coverage or charging them extra fees for it.
The case, California v. Texas, No. 19-840, was brought by Republican officials who said the mandate requiring health insurance coverage became unconstitutional after Congress in 2017 eliminated the penalty for failing to get coverage because the mandate could no longer be justified as a tax. .
The argument was based on the court’s 2012 ruling, in which Chief Justice John G. Roberts Jr., joined at the time by the court’s liberal wing, said the authorization came from Congress’ tax-assessment authority.
The new challenge was largely successful in the lower courts. A federal judge in Texas ruled the entire law invalid, but delayed the effect of his ruling until the case could be appealed. In 2019, the US Court of Appeals for the Fifth Circuit, in New Orleans, agreed that the mandate was unconstitutional, but refused to rule on the fate of the remainder of the health law, and asked the lower court to reconsider the question in more detail. .
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