The United States Supreme Court has announced it will consider appeals by both sides of an ongoing legal battle over the future of the Affordable Care Act (ACA). This would be the third time the decade-old healthcare reform legislation has been brought before the court to resolve questions of constitutionality, following previous challenges heard in 2012 and 2015.
This latest legal fight was triggered by a group of states arguing that the individual mandate, which had its tax penalty reduced to zero in 2017, is unconstitutional in its current state. An additional component of this argument is that prior court cases found the mandate to be an essential and inseparable part of the ACA which is required for its overall viability. Without the individual mandate, the plaintiffs therefore contend, the entire ACA may need to be struck down.
On the other side of the debate is a group of states seeking to defend the ACA, following lower court rulings that questioned its constitutionality. The defendants contend that the theory that ACA Marketplaces would be unsustainable as a result of the zeroed mandate has been proven inaccurate. Although the past two years of Marketplace enrollment have seen slight declines, it is true that the trend of escalating Marketplace premiums leveled off in the period after the mandate penalty was zeroed. This may add credence to arguments suggesting the individual mandate is less essential to the stability of the overall ACA than originally assumed.
The scope that the Supreme Court chooses to take regarding the law will likely be the most important element of the case. If a broad scope is taken, a ruling could impact everything from Medicaid expansion programs (such as Indiana’s Healthy Indiana Plan), the Marketplace, elements of private market plans, community health centers and even Medicare. A narrow focus may only seek removal of the individual mandate from the law. In its multiple lower court appearances, this legal challenge has had mixed rulings. While some rulings suggested that the entire law is indeed unconstitutional, others focused solely on removing the individual mandate.
The court is not placing the case on an accelerated schedule, and as a result the earliest it could be heard would be October of this year. At the latest, it could be June 2021 before the high court issues a ruling. Consumers should note that their current coverage through the Marketplace is based on an annual contract; those plans would not be invalidated by potential court rulings.