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Obamacare Wins For The 3rd Time At The Supreme Court

A demonstrator holds a sign in support of the Affordable Care Act in front of the U.S. Supreme Court last November. On Thursday, the justices did just that.
Alex Brandon
A demonstrator holds a sign in support of the Affordable Care Act in front of the U.S. Supreme Court last November. On Thursday, the justices did just that.

Updated June 17, 2021 at 5:05 PM ET

The U.S. Supreme Court upheld the Affordable Care Act for the third time on Thursday, leaving in place the broad provisions of the law enacted by Congress in 201o. The vote was 7 to 2.

The opinion, written by Justice Stephen Breyer, was joined by Chief Justice John Roberts and Justices Clarence Thomas, Sonia Sotomayor, Elena Kagan, Brett Kavanaugh and Amy Coney Barrett.

Justices Samuel Alito and Neil Gorsuch dissented. They would have struck down the most popular parts of the law, including the provision barring discrimination based on preexisting medical conditions.

But the majority decision threw out the challenge to the law on the grounds that Texas and other objecting GOP-dominated states were not required to pay anything under the mandate provision and thus had no standing to bring the challenge to court.

"To have standing, a plaintiff must 'allege personal injury fairly traceable to the defendant's allegedly unlawful conduct and likely to be redressed by the requested relief,' " but "No plaintiff has shown such an injury," the court said.

The result of the decision, according to most experts, is that Obamacare would appear to be secure for the foreseeable future.

"If Obamacare is going to be dramatically changed, that's something that Congress will have to do," said Case Western law professor Jonathan Adler. "The courts will police the enforcement of this law like it does every other large regulatory statute. But if the fundamentals are going to be changed, Congress is going to have to pass legislation to do that."

Former President Barack Obama hailed the court's decision on his signature legislative achievement.

"This ruling reaffirms what we have long known to be true: the Affordable Care Act is here to stay," he said on Twitter.

President Biden, in a statement, called the opinion "a major victory for all Americans benefiting from this groundbreaking and life-changing law."

Congressional Republicans, who made repealing the ACA a centerpiece of their political strategy, appear to have acknowledged that reality.

In a statement, Rep. Kevin McCarthy, the House Republican leader and two of his top aides, said the court's decision "does not change the fact that Obamacare failed to meet its promises and is hurting hard-working American families." The statement did not mention a vow to "repeal and replace" Obamacare, a longstanding Republican promise.

The mandate, the most controversial provision of the law, was again at the core of Thursday's decision. It required that people either buy health insurance or pay a penalty. In 2012, it was upheld by a 5-4 vote, with Roberts casting the decisive fifth vote, on the grounds that the penalty fell within the taxing power of Congress.

In 2017, however, Congress got rid of the penalty after the Congressional Budget Office concluded that the law would continue to function effectively without it. That prompted the challengers to go back to court, contending that because the penalty had been zeroed out, it was no longer a tax or a mandate. What's more, they contended, because the mandate was so interwoven with the rest of the ACA, the whole law must be struck down.

Over 31 million Americans have access health insurance through the ACA — a record high since the law's inception, according to the White House. In addition, the Urban Institute reported in May that ACA premiums have gone down each of the last three years.

Many of the provisions of the ACA are now taken for granted. Up to 135 million people are covered by the ban on discrimination against those with preexisting conditions.

Young adults are now permitted to stay on their parents' insurance until age 26; copays are not permitted for preventive care; and insurance companies can no longer put lifetime caps on benefits, are required to spend 80% of premiums on medical coverage and are barred from discrimination based on factors like gender.

In addition, Medicaid coverage was greatly expanded after all but a dozen states took advantage of the ACA to expand federally subsidized coverage under the program. Among those who have benefited are many who lost their health insurance when they lost their jobs in the COVID-19 pandemic.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Nina Totenberg is NPR's award-winning legal affairs correspondent. Her reports air regularly on NPR's critically acclaimed newsmagazines All Things Considered, Morning Edition, and Weekend Edition.