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Obamacare Survives Latest Supreme Court Challenge

WASHINGTON — The Affordable Care Act on Thursday survived a third major challenge as the Supreme Court, on a 7-to-2 vote, turned aside the latest effort by Republicans to kill the health care law.

The legislation, President Barack Obama’s defining domestic legacy, has been the subject of relentless Republican hostility. But attempts in Congress to repeal it failed, as did two earlier Supreme Court challenges, in 2012 and 2015. With the passing years, the law gained popularity and became woven into the fabric of the health care system.

On Thursday, in what Justice Samuel A. Alito Jr. called, in dissent, “the third installment in our epic Affordable Care Act trilogy,” the Supreme Court again sustained the law. Its future now seems secure and its potency as a political issue for Republicans reduced.

The margin of victory was wider than in the earlier cases, with six members of the court joining Justice Stephen G. Breyer’s modest and technical majority opinion, one that said only that the 18 Republican-led states and two individuals who brought the case had not suffered the sort of direct injury that gave them standing to sue.

Chief Justice John G. Roberts Jr., who had cast the decisive vote to save the law in 2012, was in the majority. So was Justice Clarence Thomas, who had dissented in the earlier decisions.

“Whatever the act’s dubious history in this court,” Justice Thomas wrote in a concurring opinion, “we must assess the current suit on its own terms. And, here, there is a fundamental problem with the arguments advanced by the plaintiffs in attacking the act — they have not identified any unlawful action that has injured them.”

Justices Sonia Sotomayor, Elena Kagan, Brett M. Kavanaugh and Amy Coney Barrett also joined Justice Breyer’s majority opinion. At Justice Barrett’s confirmation hearings last year, Democrats portrayed her as a grave threat to the health care law.

The court did not touch the larger issues in the case: whether the bulk of the law could stand without a provision that initially required most Americans to obtain insurance or pay a penalty.

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

In the 11 years since Mr. Obama signed the legislation into law, Republicans have assailed the Affordable Care Act as a step toward socialized medicine, government intrusion into health care decisions and a costly boondoggle.

They challenged it on a variety of fronts in the courts and made calls for its repeal a staple of their campaigns. But some of its provisions, like coverage for pre-existing conditions and for adult children up to age 26, proved popular across party lines. Even when they controlled the Senate, the House and the White House, Republicans failed to muster the votes to repeal the law — and despite President Donald J. Trump’s promises to deliver a better alternative, he never produced a detailed proposal of his own.

While health care remains a potent political issue — and the Affordable Care Act has shortcomings Democrats have acknowledged — the latest court ruling suggests that Republican chances of winning a legal battle to kill it are now much diminished.

“With millions of people relying on the Affordable Care Act for coverage, it remains, as ever, a BFD,” President Biden said on Twitter after the ruling, alluding to his obscenity-punctuated comment to Mr. Obama on the day in March 2010 the bill was signed into law that the legislation was a big deal. Mr. Biden has signaled that he now wants to build on the legislation through a series of steps to expand access to health care.

Republicans were critical of the decision but suggested the battle would now focus on the policy fight in Congress.

“The failed Obamacare system will stagger on as a result of this decision,” said Senator John Barrasso, Republican of Wyoming.

“Every American’s health care has been harmed by Obamacare,” he said. “Republicans remain focused on making health care more affordable for families in Wyoming and around the country. Democrats keep pouring money into Obamacare instead of fixing the many problems facing patients and health care providers.”

The challengers in the case sought to take advantage of the 2012 ruling, in which Chief Justice Roberts upheld a central provision of the law, its individual mandate requiring most Americans to obtain health insurance or pay a penalty, saying it was authorized by Congress’s power to levy taxes.

They argued that the mandate became unconstitutional after Congress in 2017 eliminated the penalty for failing to obtain coverage because it could no longer be justified as a tax. They went on to say that this meant the rest of the law must also fall.

The challenge was largely successful in the lower courts. A federal judge in Texas ruled that the entire law was invalid, but he postponed the effects of his ruling until the case could be appealed. In 2019, the United States Court of Appeals for the Fifth Circuit, in New Orleans, agreed that the mandate was unconstitutional but declined to rule on the fate of the remainder of the health law, asking the lower court to reconsider the question in more detail.

Justice Breyer did not address most of the arguments that were the basis of those decisions, focusing instead on whether the plaintiffs were entitled to sue at all.

The two individuals, he wrote, suffered no harm from a toothless provision that in effect merely urged them to obtain health insurance. Similarly, he wrote, the states did not sustain injuries tied directly to the elimination of the penalty that had been part of the individual mandate.

The states argued that the revised mandate would cause more people to take advantage of state-sponsored insurance programs. Justice Breyer rejected that theory.

“The state plaintiffs have failed to show,” he wrote, “that the challenged minimum essential coverage provision, without any prospect of penalty, will harm them by leading more individuals to enroll in these programs.”

“Neither logic nor intuition suggests that the presence of the minimum essential coverage requirement would lead an individual to enroll in one of those programs that its absence would lead them to ignore,” Justice Breyer wrote. “A penalty might have led some inertia-bound individuals to enroll. But without a penalty, what incentive could the provision provide?”

In a vigorous dissent, Justice Alito, joined by Justice Neil M. Gorsuch, said the third installment of the court’s Affordable Care Act trilogy “follows the same pattern as Installments 1 and 2.”

“In all three episodes, with the Affordable Care Act facing a serious threat,” he wrote, “the court has pulled off an improbable rescue.”

Justice Alito wrote that the court has routinely found that states have standing to challenge federal initiatives. “Just recently,” he wrote, “New York and certain other states were permitted to challenge the inclusion of a citizenship question in the 2020 census even though any effect on them depended on a speculative chain of events.”

He said there were “novel questions” about whether the individual plaintiffs could sue. But “the states have standing for reasons that are straightforward and meritorious,” he wrote. “The court’s contrary holding is based on a fundamental distortion of our standing jurisprudence.”

Unlike the majority, Justice Alito went on to address the larger issues in the case, California v. Texas, No. 19-840, saying the mandate was now unconstitutional and could not be severed from much of the rest of the law.

Had Justice Alito’s view prevailed, the nation’s health care system would have experienced an earthquake.

Striking down the Affordable Care Act would have expanded the ranks of the uninsured in the United States by about 21 million people — a nearly 70 percent increase — according to recent estimates from the Urban Institute.

The biggest loss of coverage would have been among low-income adults who became eligible for Medicaid under the law after most states expanded the program to include them. But millions of Americans would also have lost private insurance, including young adults whom the law allowed to stay on their parents’ plans until they turned 26 and families whose income was modest enough to qualify for subsidies that help pay their monthly premiums.

A ruling against the law would also have doomed its protections for Americans with past or current health problems. The protections bans insurers from denying them coverage or charging them more for pre-existing conditions.

“Today’s decision means that all Americans continue to have a right to access affordable care, free of discrimination,” said Xavier Becerra, the secretary of health and human services, who in his previous job as California’s attorney general helped defend the law in Thursday’s case.

Mr. Biden has said he wants to build on the Affordable Care Act through steps like expanded health insurance subsidies, and some Democrats are pushing for bigger proposals like expanding Medicare coverage to more people.

Republicans suggested on Thursday that their focus would now be less on seeking to repeal the law than on the debate in Congress and on the campaign trail for 2022 over how to address issues like the affordability of health insurance.

“While the Supreme Court ruled today that states do not have standing to challenge the mandate, the ruling does not change the fact that Obamacare failed to meet its promises and is hurting hard-working American families,” the three top Republicans in the House, Representatives Kevin McCarthy, Steve Scalise and Elise Stefanik, said in a statement. “Now, Congress must work together to improve American health care.”

Author: Adam Liptak
This post originally appeared on NYT > Top Stories

Obamacare now appears safe. The battle over its future continues.

“It’s significant in that it allows all parties to move on, to either build up or tear down — but they have to do so legislatively,” said health care strategist Chris Jennings, who has advised the last three Democratic presidents. “The courts are basically saying: Stop it, move on, you have every ability if you want to alter this bill, but do it by the books.”

The ruling will give new energy to Democratic efforts to build on Obamacare, through richer insurance subsidies and potentially a public option. And Republicans, who never settled on the “replace” part of their anti-Obamacare pledge, condemned the law’s high costs in the aftermath of Thursday’s ruling and vowed to fight Democratic proposals to expand government coverage.

“I suspect we’re going to continue to be working to try to make health care more accessible,” said Sen. John Cornyn (R-Texas), whose home state led the latest legal threat to the ACA. “I think three times the Supreme Court’s upheld the Affordable Care Act, and I think we need to move on.”

For Democrats, the court decision could also bring on a long-delayed reckoning over the party’s own vision for a health care system, now that the latest legal challenge to the ACA has collapsed. Democrats universally agree that the ACA has its problems — high premiums, large deductibles, and a gaping coverage gap in the dozen, predominately Republican-led states refusing to join the law’s Medicaid expansion.

“For many years one of the biggest obstacles to making big progressive steps on health care was the mantra that we needed to implement Obamacare and then defend Obamacare,” said Adam Green, co-founder of the Progressive Change Campaign Committee. “It was a very existential block to going forward, just keeping the law alive. Now that it seems quite safe, there’s more flexibility across the Democratic Party to take bold steps.”

But Democrats disagree on the next steps, and Obamacare’s future could look very different depending on where party leaders steer the ship.

President Joe Biden, who campaigned on more seismic changes to the ACA like a public option and lowering the Medicare age to 60, has pulled back since taking office to focus on more incremental policies that won’t disturb intraparty harmony or the powerful health care industry. The Democrats’ Covid relief package in March temporarily boosted Obamacare subsidies by nearly 30 percent, aiming to lower costs for low-income Americans and draw more middle-income families into the law’s insurance marketplaces. Biden is pushing to make those subsidies permanent in infrastructure legislation, prioritizing them over other Democratic health care proposals.

“How much further will the ACA in all its various forms be expanded?” said Tom Miller, a resident fellow in health care policy at the conservative American Enterprise Institute. That could become a long-running dispute between Democrats and Republicans as they trade control of Washington.

“That’s where the point of engagement is, and where it may shift back and forth, instead of, ‘I’ve got another lawsuit for you,’” Miller added.

While Republicans broadly oppose the expansion of insurance subsidies, they’d be powerless to stop it from happening in this Congress if Democrats include the aid in an infrastructure package they advance along strictly party lines.

The prospects for other Democratic health care priorities are uncertain. Biden has steered clear of substantive debate on other campaign proposals, like lowering Medicare’s eligibility age, government-mandated drug price negotiations and creating a government-run insurance option.

The White House has even taken a back seat on one of Biden’s most full-throated campaign priorities: finessing a federal work-around for coverage in the dozen states that have rejected federal help to expand Medicaid to roughly 2 million low-income adults. Democratic lawmakers have been trying to work out the details for months, hoping to strike an approach that won’t anger the health industry or states that already joined the optional Obamacare program.

With razor-thin margins in Congress, Democrats have just a small window to deliver on their health plans before the 2022 midterm elections. Debate over the party’s health care vision was already in full swing this year, and it could heat up now that Obamacare has been secured by the high court.

Sen. Bernie Sanders (I-Vt.), who as budget committee chairman will have strong sway over Democrats’ infrastructure legislation, insisted Thursday he won’t give up on lowering the Medicare age this Congress. He’s also called for expanding the program to cover vision, dental and hearing.

“There are millions of older workers who would like to get Medicare who today can’t, which is why we’ve got to lower the age, and there are millions more walking around, who cannot hear, can’t afford eyeglasses, and can’t afford dental,” he added, according to a Capitol Hill press pool report.

Senate health committee chair Patty Murray (D-Wash.) and House Energy and Commerce Chair Frank Pallone (D-N.J.) have started collecting feedback on a public option, kicking off what could be a lengthy process to develop a policy Democrats could agree on. The idea has gained support since it was jettisoned from the ACA during the law’s drafting, but there are different ways of designing a public option.

“But it’s still going to be difficult because it is a very important and major change in the law, and the Congress doesn’t move very quickly,” said Henry Waxman, one of Obamacare’s lead authors in Congress who now helms his own consulting firm.

Rachel Roubein contributed to this report.

Author: Susannah Luthi
This post originally appeared on Politics, Policy, Political News Top Stories

Obamacare Is Here to Stay. Brace for New Health Care Battles.

Efforts to move toward universal health coverage are complicated, with potentially high costs, difficult policy trade-offs and the risks of industry opposition.

Even policies with widespread support in Congress could face intense lobbying campaigns from opponents who fear additional government intervention and loss of revenue. One example is a proposal to eliminate surprise medical billing. It enjoyed bipartisan political support but faced an avalanche of industry opposition. Its success was not assured, but it passed in December.

Just this week, Senate leadership is considering a legislative package that could include an expansion of Medicare to cover more middle-aged Americans and to provide dental, vision and hearing benefits. The provision would be costly, and will probably face resistance from health industries. Other ideas, like President Biden’s campaign proposal of a government-run “public option” that Americans would have the choice to purchase, are at the earliest stages of conception.

And the post-Obamacare dream of many progressives, “Medicare for all,” continues to divide the party. Such a policy would face fierce opposition from hospitals, doctors and insurers, who already have an advocacy group to combat further government involvement in health care.

The Affordable Care Act still has holes that have proved challenging to fix. The 2012 Supreme Court decision that upheld the individual mandate also made the law’s Medicaid expansion provisions optional. Twelve states do not participate in that program, leaving millions of low-income Americans without coverage. Generous incentive payments included in the most recent stimulus package have not been enough to convince any of the holdout states to join.

Some political voices are still calling for the end of Obamacare, but they are growing rarer. In 2012, nearly every leading Republican politician expressed disappointment or anger at the first Supreme Court decision upholding the core of the law. On Thursday, few commented.

Ted Cruz, the Texas senator who once helped drive a government shutdown demanding an Obamacare repeal bill, issued a statement that reiterated his objections to the law. Josh Hawley, a Republican senator from Missouri who had helped bring the suit as his state’s attorney general, said in response to a reporter’s question that the Supreme Court had made its stance clear. (He did tweet about another Supreme Court case decided Thursday.)

Author: Margot Sanger-Katz and Sarah Kliff
This post originally appeared on NYT > Top Stories

Texas-led lawsuit against ‘Obamacare’ thrown out by US Supreme Court

Texas-led lawsuit against Obamacare
In this Nov. 5, 2020 file photo, The Supreme Court is seen in Washington. (AP Photo/J. Scott Applewhite)

WASHINGTON (KXAN/AP) — The United States Supreme Court threw out a lawsuit Thursday against the Affordable Care Act led by Texas Attorney General Ken Paxton.

The high court voted 7-2 against the challenge to the Obama-era health care act, saying Texas and other Republican-controlled states listed as plaintiffs didn’t prove “fairly traceable” injuries or harm by the act and had no legal standing to bring the case to federal court. The vote leaves the entire law intact, and it’s the third major challenge to the act signed into law in 2010.

The court didn’t vote on the merits of the case, just that the states didn’t have proper standing to file it in federal court. Theoretically, the law can still be challenged if potential plaintiffs can prove they’ve been harmed in some way by the legislation.

Justices Samuel Alito and Neil Gorsuch were the dissenting votes. Brett Kavanaugh and Amy Coney Barrett, two of three former President Donald Trump appointees to the court, voted with the majority.

The law’s major provisions include protections for people with pre-existing health conditions, a range of no-cost preventive services and the expansion of the Medicaid program that insures lower-income people, including those who work in jobs that don’t pay much or provide health insurance.

Also left in place is the law’s now-toothless requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero.

The elimination of the penalty had become the hook that Texas and other Republican-led states, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law should fall, too.

With a more conservative Supreme Court that includes three Trump appointees, opponents of “Obamacare” hoped a majority of the justices would finally kill off the law they have been fighting against for more than a decade.

However, the third major attack on the law at the Supreme Court ended the way the first two did — with a majority of the court rebuffing efforts to gut the law or get rid of it altogether.

Political News by: Billy Gates, Associated Press

Author: Billy Gates
This post originally appeared on KXAN Austin