As the Supreme Court refused to strike down the Affordable Care Act a third time, Modern Healthcare looks back at the major litigation President Barack Obama's 2010 healthcare law has faced.
2012: The first challenge
After Congress passed the Affordable Care Act and HHS regulations started to take effect, 28 states sued to strike down the ACA's individual mandate in an effort to declare the entire law unconstitutional.
In 2011 the Supreme Court agreed to hear two of the state lawsuits:
- National Federation of Independent Business v. Sebelius ,which challenged the constitutionality of the individual mandate and severability, the idea if a part of a law is illegal other parts can still apply.
- Florida v. HHS, which challenged the Medicaid expansion provision.
In a decision released June 28, 2012, the high court upheld the individual mandate as a valid exercise of Congress's taxing power. On Medicaid expansion, the court ruled that Medicaid funding could not be withheld from states, leaving Medicaid expansion as an option for states but not a requirement.
2015: The second challenge
On June 25, 2015, the justices rejected a challenge to the ACA that tax credits to qualifying people seeking insurance only applied to those using state exchanges and not those set up by HHS.
2021: The third challenge
After a Republican-led Congress zeroed out the individual mandate in 2017, a group of 20 Republican state attorneys general led by Texas sued to overturn the entire law in 2018. Seventeen states led by California opposed the Texas-led effort in court after the Trump administration's Justice Department declined to defend the law. The case became California v. Texas.
In February 2018, a federal judge in Texas ruled the ACA unconstitutional, holding that the individual mandate was an essential part of the law.
The opposing states appealed, reasoning the mandate hadn't been removed but only reduced and Congress had the power to adjust it in the future. The Fifth U.S. Circuit Court of Appeals in December 2019 agreed the individual mandate was unconstitutional but disagreed that the entire law was illegal.
On Thursday, the Supreme Court rejected the case based on standing. In a 7-2 decision, it said the plaintiffs had not shown "a past or future injury fairly traceable to defendants' conduct enforcing the specific statutory provision they attack as unconstitutional."