Supreme Court to Rule on ACA's Fate After 2020 Election

The Supreme Court agreed Monday to a hear an appeal by a coalition of 20 mainly Democratic states, which are hoping for a reversal of a Fifth Circuit Court of Appeals ruling, which held the Affordable Care Act’s individual mandate is unconstitutional and called into question whether the remaining provisions of the law could still stand.

Among those provisions, of course, are the Biologics Price Competition and Innovation Act (BPCIA). The Department of Justice had argued that the Fifth Circuit should not only affirm that decision, but it should further find that other ACA provisions should also be struck down if the individual mandate was not severable from the rest of the statute.

Any effect on the BPCIA will hinge on the question of severability, observers have said.

In a statement, AARP’s Nancy LeaMond, executive vice president and chief advocacy and engagement officer praised the decision to review the case, Texas v Azar.

“We urge the Court to uphold the ACA by overturning the lower appellate court’s decision,” she said. "A final ruling by the Supreme Court is needed to end years of uncertainty for millions of Americans who worry that they will lose access to critical health care coverage and essential consumer protections. It would also end the uncertainty for insurers and state and local governments who must make advance decisions each year about participating in the ACA Marketplaces and other ACA programs.”

However, a decision in the case will not come until after the November 2020 presidential election. The new term for the court does not begin until October.

There are no changes to the ACA while the case continues.

California Attorney General Xavier Becerra, leading a coalition of 20 states and Washington DC, applauded the high court’s decision. In a statement, his office said it urged the court to take up the case to “resolve the uncertainty created by the Fifth Circuit decision, which threatens the health of millions of Americans, as well as doctors, clinics, and the healthcare market.”

At issue is whether the other parts of the law can survive without the mandate; the Republican-led states, led by Texas, said that when the tax penalty was eliminated under President Donald Trump's 2017 tax cut package, it also made the ACA unconstitutional. Democratic states opposed the challenge, saying that reducing the tax penalty to zero did not eliminate the requirement.

“The Fifth Circuit correctly applied existing US Supreme Court precedent when they ruled that the individual mandate itself was unconstitutional, said Texas Attorney General Ken Paxton in a statement. “Without the individual mandate, the entire law becomes unsupportable. The federal government cannot order private citizens to purchase subpar insurance that they don’t want, and I look forward to finally settling the matter before the US Supreme Court.”