Supreme Court Declines to Expedite Review of Challenge to ACA

The Supreme Court in January denied a motion to expedite a challenge to the Affordable Care Act (ACA) so that it could be considered before the 2020 election in November.

Without comment, the justices turned down a motion by the House of Representatives and Democratic-led states to expedite review of a decision in December by a panel of the U.S. Court of Appeals for the 5th Circuit in the case Texas, et al., v. United States of America, et al., and California, et al.

That panel had agreed with a lower court that had ruled in 2018 that the so-called “individual mandate”—requiring individuals to buy health insurance or pay a tax—was unconstitutional; however, the panel sent back to the lower court for review the question of whether the entire ACA was therefore invalidated.

The practical effect of the Supreme Court’s denial of the motion to expedite review of Texas v. USA is that the ACA will stay in effect through the November election. The Democratic-led states that filed the motion to expedite had hoped to make the ACA an election issue.

The ACA, President Obama’s signature legislative achievement, has been the source of much litigation, especially regarding the individual mandate. In 2018 U.S. District Judge Reed O’Connor agreed with plaintiffs in Texas v. USA that the individual mandate was unconstitutional and further ruled that the entire act was negated because the mandate was essential to it. However, O’Connor stayed his decision, leaving the ACA in effect.

The December 2019 ruling by the 5th Circuit of Appeals requires O’Connor to undertake a more rigorous examination of whether parts of the law should remain in place. Such an examination would likely take months and push a final Supreme Court decision on the issue far into the future.

Immediately following O’Connor’s 2018 ruling, APA leaders issued a statement “vigorously” opposing it. Five months later, in April 2019, APA formalized its protest by joining an amicus brief with four other medical organizations, arguing that O’Connor was in error. The other groups that signed on to the brief are the AMA, American College of Physicians, American Academy of Family Physicians, and American Academy of Pediatrics.

Wholesale invalidation of the ACA would “have a devastating impact on patients and the American health care system,” APA and the four groups argued. They cited a March 2019 Urban Institute analysis (“State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA”), which found that if the entire law were eliminated, the number of uninsured people in the United States would rise to 50.3 million, an increase of 65.4%, or 19.9 million, people. The analysis further found that enrollment in Medicaid and the Children’s Health Insurance Program would fall by 15.4 million people through the elimination of the ACA’s Medicaid expansion. ■