Supreme Court will decide the fate of Obamacare

A demonstrator celebrated outside the U.S. Supreme Court in 2015 after the court voted to uphold key tax subsidies that are part of the Affordable Care Act. But federal taxes and other measures designed to pay for the health care the ACA provides have not fared as well. (Andrew Harrer/Bloomberg via Getty Images)

A demonstrator celebrated outside the U.S. Supreme Court in 2015 after the court voted to uphold key tax subsidies that are part of the Affordable Care Act. But federal taxes and other measures designed to pay for the health care the ACA provides have not fared as well. (Andrew Harrer/Bloomberg via Getty Images)

The Supreme Court agreed on Monday to decide a lawsuit that threatens the Obama-era health care law, but the decision is not likely until after the 2020 election.

The court said it would hear an appeal by 20 mainly Democratic states of a lower-court ruling that declared part of the statute unconstitutional and cast a cloud over the rest.

Defenders of the Affordable Care Act argued that the issues raised by the case are too important to let the litigation drag on for months or years in lower courts and that the 5th U.S. Circuit Court of Appeals in New Orleans erred when it struck down the health law’s now toothless requirement that Americans have health insurance.

The case will be the third major Supreme Court battle over the law popularly known as Obamacare since its passage in 2010. The court has twice upheld the heart of the law, with Chief Justice John Roberts memorably siding with the court’s liberals in 2012, amid President Barack Obama’s reelection campaign. The majority that upheld the law twice remains on the court, Roberts and the four liberal justices.

The Trump administration’s views on the law have shifted over time, but it has always supported getting rid of provisions that prohibit insurance companies from discriminating against people with existing health ailments. Congressional repeal of the law narrowly failed in 2017, when the Republicans controlled the House and the Senate.

The entire health care law is in effect pending the ongoing court case. About 20 million people now have coverage through the ACA, including its subsidized private insurance and Medicaid expansion.

The Democratic states had asked for a fast-track review with a decision by late June, before the 2020 elections in November. Instead, the justices probably will hear arguments in the fall, with a decision likely in the spring of 2021.

The high court action takes the case out of the hands of a federal district judge in Texas who had previously struck down the entire law.

The new case stems from the 2017 passage of tax legislation that left the health insurance mandate in place but eliminated the financial penalty for not buying insurance. Congress made no other changes to the law.

Texas and other Republican-led states sued, arguing that the elimination of the penalty rendered the mandate unconstitutional. U.S. District Judge Reed O’Connor agreed, adding that the mandate was so central to the law that without it the rest of the law must fall, too.

While finding the health law’s individual mandate to be unconstitutional, the appeals court made no decision on such popular provisions as protections for people with preexisting conditions, Medicaid expansion and coverage for young adults up to age 26 on their parents’ policies.

The 5th Circuit sent the case back to O’Connor to determine whether other parts of the law can be separated from the insurance requirement and thus remain in place.

Besides expanding insurance coverage, the 900-page law also made many changes to other programs, including Medicare, community health centers and fraud-fighting. Sorting out whether some provisions could remain while others go with the insurance mandate would be a colossal effort.

The justices on Monday granted two different appeals, one from the Democratic states and the other from the Republican side, that essentially put all the issues in front of the court, from the insurance mandate to the validity of the entire law if the mandate does not survive. The court took no action on a separate appeal filed by the Democratic-led House of Representatives.

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