The Fallout of a SCOTUS Health-Care Decision Could Be Quick, Devastating, and Irreversible

The Fallout of a SCOTUS Health-Care Decision Could Be Quick, Devastating, and Irreversible

Millions of Americans could lose their insurance—and neither Joe Biden nor the states will be in a good position to do much about it.

This morning, the United States Supreme Court will hear the latest challenge to the Affordable Care Act, with a decision to come this spring. If the Court invalidates the law, the result will be catastrophic: Without the federal funding that supports the law’s coverage expansions, millions of Americans will quickly lose their health insurance—and neither President Joe Biden nor the states will be in a good position to do much about it.

To recap: In late 2012, by a 5–4 vote, the Supreme Court held that it would be unconstitutional for Congress to force people to buy insurance. The Court nonetheless upheld the Affordable Care Act’s individual mandate by reading it as giving people a choice: Either buy insurance or pay a tax penalty.

Five years later, in 2017, Congress zeroed out that penalty for going without insurance. Almost immediately, a group of red states filed suit, arguing that the now-toothless instruction in the ACA that people “shall” buy insurance could no longer be construed as offering people a choice.

Instead, they argued, the instruction could be read only as a coercive—and thus unconstitutional—command. The challengers further argued that because the individual mandate was an essential part of the ACA, the rest of the law had to fall with it.