SCOTUS Will Review ACA Constitutionality, Decision Expected 2021

March 02, 2020 - Update 03/03/2020: This article has been updated to include a statement from America’s Health Insurance Plans (AHIP) on the Supreme Court’s decision to review the case.

The Supreme Court has agreed to review the Fifth Circuit Court’s decision on the unconstitutionality of the individual mandate and to review the constitutional status of the Affordable Care Act as a whole.

This is a major win for those defending the Affordable Care Act. Without this decision by the court, the nation would have had to wait for the lower courts to review the Affordable Care Act in light of the Fifth Circuit Court’s decision.

California Attorney General Xavier Becerra, who leads the ACA’s defense, emphasized the ACA's track record, including what many see as considerable improvements in coverage.

“Our health is the most precious resource we have—we should all be working to improve healthcare, instead of ripping coverage away from those most in need,” he said in an emailed statement. “As Texas and the Trump Administration fight to disrupt our healthcare system and the coverage that millions of people rely upon, we look forward to making our case in defense of the ACA. American lives depend upon it.”

READ MORE: Post-ACA Access to Care, Coverage Disparities Shifted in 2017

Others, however, have claimed that, despite insurance gains, the ACA's Medicaid expansion led to decreased affordable access to care.

The court also granted that 33 state hospital associations could file an amici curiae brief.

Oral arguments will last for one hour before the court makes its decision. Based on the Supreme Court’s processes, since the case was granted after mid-January the oral argument will be heard around October of 2020, followed by the final verdict sometime the next year. So there is still a long wait in store before the Affordable Care Act’s fate in this case will be determined.

The individual mandate, which once produced a penalty for anyone who did not have health insurance, has been ruled unconstitutional by a lower court.

The fact that the individual mandate was deemed a tax preserved the Affordable Care Act in its near-death experience in 2012. Opponents of the ACA alleged at the time that Congress could not coerce the public into buying a product by placing a penalty on it. However, the Supreme Court ruled that the individual mandate was not a penalty but a tax, which Congress does have the power to levy.

READ MORE: ACA Leads to Insurance Gains, Affordable Access to Care Wanes

Congress’s decision to zero-out the individual mandate in 2017 gave rise to the present case. If there is no financial cost imposed for not having insurance, then there is no tax, opponents argued, and thus the individual mandate is unconstitutional. Furthermore, if there is no tax, then, based on the Supreme Court’s previous reasoning, the entire law cannot be constitutional, the ACA’s opposition extrapolated.

The Fifth Circuit Court of Appeals conceded to at least one facet of this logic. The individual mandate, now voided, is no longer a tax. This makes the mandate itself unconstitutional, the Fifth Circuit agreed.

“The individual mandate injures both the individual plaintiffs, by requiring them to buy insurance that they do not want, and the state plaintiffs, by increasing their costs of complying with the reporting requirements that accompany the individual mandate,” the court stated in its final opinion. 

“The individual mandate is unconstitutional because it can no longer be read as a tax, and there is no other constitutional provision that justifies this exercise of congressional power.”

However, the Fifth Circuit balked at the district court’s lack of thoroughness in assessing the impacts of such a decision on the law’s constitutionality as a whole and rejected the responsibility of making that determination. It sent the decision back to the lower court to produce a better assessment of the implications.

READ MORE: Supreme Court Will Not Expedite ACA Constitutionality Review

California—leading the states in defense of the law—asked for an expedited review which was denied. 

However, while it will not expedite the process, this latest news from the Supreme Court communicates that it will review the case.

The court will be reviewing three fundamental questions: the standing of the plaintiffs and defendants, the individual mandate’s constitutionality, and whether or not it is severable from the rest of the law.

"We applaud the Supreme Court’s decision to grant certiorari in TX v US, which will remove the continued legal uncertainty that undermines the stability of coverage for nearly 300 million Americans," said Matt Eyles, president and chief executive officer of America’s Health Insurance Plans (AHIP) 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 health care system."

The oral arguments will likely be scheduled at a time when the future of the nation’s healthcare is already at stake—the 2020 election.