Health Care Policy
September 13, 2021
Will changes to the Affordable Care Act prove effective?

The survival of the Affordable Care Act (ACA) appears more assured than ever after the Supreme Court rejected the latest Republican attempt to overturn the 2010 law. In the wake of the June ruling, the discussion in Washington has shifted to how the landmark law, which sought to lower the nation’s uninsured rate, can be expanded. President Biden has taken executive actions aimed at increasing health insurance access, and congressional Democrats are considering expanding Medicare, the insurance program for Americans 65 and older. A new law increased subsidies for many enrollees on the ACA marketplace and temporarily subsidized health insurance for the recently unemployed. The COVID-19 pandemic continues to put medical care and insurance coverage at the forefront of American politics.

Photo of President Biden marking anniversary of ACA signing on March 23, 2021. President Biden on March 23 marks the anniversary of the Affordable Care Act being signed into law during a visit to a hospital in Columbus, Ohio. Biden has issued a series of executive orders to strengthen the ACA. (AFP/Getty Images/Jim Watson)

On June 17, the Affordable Care Act — also known as Obamacare, after former President Barack Obama, who championed its passage — survived its third major legal challenge at the U.S. Supreme Court since 2012. The court ruled 7-2 in California v. Texas against 18 Republican-led states and two individuals, finding that the plaintiffs did not have standing to sue. This allowed the court to sidestep the substantive question raised in the case: whether most of the law could stand without the individual mandate, a provision that required most Americans to get health insurance or pay a penalty tax. 1

The plaintiffs had argued that because the Republican-controlled Congress reduced the penalty to zero in 2017, the mandate was now unconstitutional, since the fee could no longer be considered a tax. They further argued that the mandate was inseverable from the rest of the law, and thus the court should find most of the ACA unconstitutional. The court’s ruling did not surprise court-watchers, as the justices expressed skepticism about the plaintiffs’ logic during oral arguments in November 2020.