Patients, seniors, doctors, hospitals, state lawmakers and voters are owed a swift answer from the U.S. Supreme Court about whether the Affordable Care Act (ACA) will survive the latest legal challenge to its existence. The court needs to remove the uncertainty hovering ominously over this landmark measure, one whose sprawling web of assistance programs consumers, hospitals and states have come to rely on for quality, accessible care.
That the fate of the 2010 law is dependent on the courts for the third time in a decade is exasperating. Twice already, battles over the ACA’s constitutionality have been fought all the way to the Supreme Court. Twice, justices there have upheld the law. Now, a third challenge, one that’s essentially a vanity project led by a headline-seeking Texas attorney general, is gaining ill-deserved momentum.
The legal argument in this dubious Texas lawsuit is the flip side of the original 2012 Supreme Court challenge to the law. Back then, the ACA’s earliest opponents argued that the law was unconstitutional because it required people to buy insurance. The Texas AG now argues that the law is unconstitutional because Congress essentially gutted the purchase requirement in 2017 during an end-of-the year tax bill.
A U.S. District Court judge in Texas somehow was blinded to the irony of this argument and ruled in the Texas AG’s favor. Last month, a Fifth Circuit Court of Appeals panel essentially agreed with the lower court. In a 2-1 ruling, the justices decided to send the case back to the lower court to decide which parts of the law, if any, could be left intact. Minnesota is one of more than a dozen states that have filed a motion with the Supreme Court to review the case before the lower court acts.
The implications are enormous. Millions of Americans depend on the financial aid the law provides to buy private insurance. In Minnesota, the average household that applied for help through MNsure received $5,244 to buy coverage in 2020. That aid could be gone next year or in the future. The fate of the Medicare “doughnut hole” is equally uncertain, leaving seniors with frightening questions about how they’ll be able to afford medications.
The questions about the law’s future are also an absolute nightmare for lawmakers. One of the ACA’s pillars involved expanding access to state-run public medical assistance programs, with the federal government picking up most of the tab. In Minnesota, that allowed the state to cover an additional 209,000 people. Federal dollars available through the ACA’s “Basic Health Plan” program also allowed officials to bolster MinnesotaCare benefits and significantly offset the state’s financial responsibility for this program.
Lawmakers in Minnesota and elsewhere will have to make decisions about the future financing of these vital medical assistance programs, potentially without the generous flow of federal aid that has supported them thanks to the ACA. They need answers now from the Supreme Court about the law’s future, not at some point as the case wends its way though the system. The court’s obligation to consumers is even greater. If the Texas-led suit nullifies benefits that up to 20 million people now rely on, the nation needs to know now so it can prepare to mitigate the damage. Voters this election year also should hear what plans candidates have if the ACA is struck down.
“When I voted for the ACA in Congress 10 years ago, I didn’t think I’d be defending it in court a decade later,” Minnesota Attorney General Keith Ellison said. “While it’s far from perfect, it’s insured hundreds of thousands of Minnesotans who were uninsured and provided millions with the peace of mind that their pre-existing conditions, preventive care, and adult children would be covered.
“It’s contemptible that politicians who would take all that coverage away from people have had 10 years to come up with their own solution and have just plain refused to do so. And it’s offensive that they’ve let millions worry for years about whether they and their families will lose the coverage they won under the ACA, and if they’ll be bankrupted if they do.”