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There have been fierce advocates on both sides of the Affordable Care Act (ACA) since its passage. Politicians, health insurance providers, and consumers alike weigh in regarding the platform’s various advantages and disadvantages. But no opinion maybe matters more than the official rulings of the U.S. Supreme Court. After all, that is the bench of federal justices who will decide the fate of the ACA and its many facets.  

Today, we’ll look back at the history of the ACA in the Supreme Court and analyze past sentiments. The fate of the ACA, and all of the businesses growing within its ecosystem, have ultimately lied in the hands of a few. And future trajectories suggest the ACA is in a prime position to thrive. 

The ACA Disrupted an Industry 

The Patient Protection and Affordable Care Act was signed into law on March 23, 2010, by then-President Barack Obama. The ACA intended to disrupt the health insurance industry in a big way. Key provisions spoke directly to address skyrocketing healthcare costs facing Americans.  

But there are also elements of the platform that would provide more industry oversight regarding health insurance providers, including coverage determination practices and monthly premiums. There was also a need to improve health condition prevention efforts since some individuals couldn’t afford routine screenings and annual physician visits. The ACA set out to be the magic wand answer to reducing abuse, uncompensated care, and healthcare fraud, as well. On the surface, there didn’t seem to be any immediate disadvantages, making Obamacare a widely supported initiative for many. But with every new policy, comes insights and opposition. And while the ACA is a duly enacted law, the debate continues regarding its constitutionality. 

Some health insurance providers and leaders within the industry saw immediate challenges. However, there were significant benefits for the millions of Americans who were underinsured and to those who had coverage that the ACA made much better. The ACA also sought to expand Medicaid eligibility to Americans earning up to 138 percent of the federal poverty level. 

The Health Insurance Marketplace served as the channel with which consumers could directly and efficiently find and enroll in affordable insurance. Removing penalties and denials for pre-existing conditions, the ACA offered solutions to an even broader pool of individuals. And as an additional preventive measure, the ACA required health insurance providers to cover a predetermined roster of essential health benefits. 

To many critics, the health industry served mostly in a treatment capacity and didn’t focus enough on prevention methods. The ACA defined Essential Health Benefits (EHBs) and imposed requirements on the insurance providers. Non-grandfathered health plans cover ten specific benefit categories, outlined by CMS: 

  1. Ambulatory services 
  2. Emergency services 
  3. Hospitalizations 
  4. Maternity & Newborn Care 
  5. Mental Health & Substance Use Disorders 
  6. Prescription Medications 
  7. Rehabilitative & Habilitative Services 
  8. Lab Services 
  9. Preventive Care & General Wellness (Chronic Condition Management Included) 
  10. Pediatric Services (Vision & Dental Included) 

The Supreme Court Reviews the ACA 

The ACA sounds great when reviewing the platform’s intentions and individual benefits. But not everyone saw this introduction as a constitutional one. This Democratic Congress initiative faced early objections from Republican lawmakers across the aisle. The challenges continued to mount from Republican governors and running candidates, who joined the nay-sayers and vowed to make every available effort to repeal the ACA in its entirety. 

The Supreme Court heard oral arguments back in March of 2012, as opposers alleged such a federally mandated structure would be unconstitutional. By June of 2012, the Supreme Court ruled by a narrow five to four margin that the ACA was, in fact, constitutional, but it made the ACA’s Medicaid expansion optional for states. And another issue brought before the court in 2015, regarding the legality of federal premium tax credits in Federally Facilitated Marketplace (FFM) states, survived another Supreme Court vote of six to three.  

Finally, when President Trump was elected, Congressional Republicans spent a year trying to repeal and replace the ACA. However, Republican legislators were unable to come up with a replacement that had enough support in the Senate. 

Challenges Along the Way 

The ACA faced political challenges right away. But the uphill battle continued as other disadvantages surfaced. Some Americans didn’t like the new law because of its complicated nature. Healthcare isn’t necessarily a cut-and-dry experience. Some earlier surveys suggest the two primary reasons Americans refused to participate were a lack of trust in the government and a political opposition to a universal health-type system. 

The ACA did prove to be rewarding for millions of individuals throughout the first few years of operation. But other side effects came to light. Some participants saw higher premiums. Taxes increased as a direct result of the ACA, and some individuals who didn’t enroll received fines. On the business side of the coin, companies facing rising benefits costs began reducing employee hours just to avoid the ACA mandates. 

Present Day Considerations 

The Supreme Court is considering the ACA yet again, prompted by the Trump Administration along with 18 Republican attorneys general, who sought to strike down the platform claiming it continues to be unconstitutional. The state attorneys general filed the suit in a Texas district court in 2018. The basis of the argument is the latest 2017 removal of the tax penalty for not having coverage makes the requirement for coverage unconstitutional and the rest of the ACA an unlawful platform. Importantly, the Supreme Court Justices seemed inclined to uphold the ACA during the oral arguments earlier this year in the Texas case. 

The ACA is still officially in place, and millions of Americans, reeling from the pandemic conditions, enroll and find affordable health plans. The Biden Administration took residence in the White House, and a new DOJ statement officially reversed the previous administration’s position. But the Supreme Court still needs to rule on this now named Texas v. California case, challenging the “Individual Shared Responsibility” mandate. Some expect a ruling by July of this year. And while the law is in jeopardy, past Supreme Court rulings and the disposition of oral arguments might predict continued support and constitutionality of the ACA. 

The Future of the ACA 

This Texas case is the latest of a long list of challenges to the ACA’s constitutionality. For now, the ACA continues to thrive, especially with the increased support and expansion of the platform by the American Rescue Plan. Despite the recent Republican appointees to the bench, industry experts still predict the ACA will remain intact. And it’s proving to be a viable lifeline for the millions of Americans who desperately need the premium tax credits, preventive care coverages, and marketplace plan options. 

Businesses that thrive within the ACA environment of engagement can expect continued growth and increased revenue opportunities. For help with leveraging those opportunities with enhanced data solutions and integration, Softheon can help. And whatever happens next, with the ACA and the Supreme Court, Softheon can help ease any necessary data and systems transitions. 

Meet the Author

Supreme Court

Josh Schultz is a Senior Policy Analyst at Softheon, where he advises the company on health policy issues affecting businesses and government health agencies. Prior to Softheon, Josh worked for a non-profit agency assisting Medicare beneficiaries, a technology company, and consulting firms.