Experts Consider Impacts of SCOTUS Affordable Care Act Decision

Since the Supreme Court dismissed California v Texas on June 17, payers and healthcare leaders have vocalized their support for the decision, their readiness to continue building on the Affordable Care Act (ACA), and their expectations about the impact that this decision could have on ongoing and future litigation.

For many experts in the healthcare industry, the result was unsurprising.

“It was not necessarily clear that the Supreme Court was going to dismiss the case on standing grounds as they have done, but any of the options they had sort of was going to result in the same outcome and the same sort of preservation of status quo for the healthcare industry,” Michael Kolber, partner at Manatt Health, told Healthcare Strategies.

Kolber noted that while the outcome was as anticipated, the agreement among the Supreme Court justices was somewhat surprising. Seven out of the nine Supreme Court justices agreed to dismiss the case. Kolber explained that this was possible because of the narrowness of the grounds for dismissal—the fact that the case was dismissed solely on the basis of standing.

Because the decision did not address the constitutionality of the individual mandate or the law in its entirety, this may not be the last legal contest that the law will face.

“It does, as a legal matter, open the door to additional challenges to the ACA and other statutes in terms of giving parties the right to sue, but whether there will be other frontal assaults on the ACA like this is really more of a political calculation than a legal one,” Kolber shared. 

“I suspect that attacks on the ACA via the individual mandates will not have many more legs, but I think the issues around preventive services and contraception, and potentially other core aspects of the ACA may still face challenges.”

Nevertheless, the outcome of this lawsuit is assured. As the Supreme Court has handed down its decision to the Fifth Circuit Court, the subsequent actions by the appeals court and district court are largely administrative.

Expected though it may be, the decision laid to rest a case that was three years in the making. Across the industry, healthcare leaders expressed relief regarding the case’s outcome.

“As a Member of Congress, I helped draft and pass the ACA. As the Attorney General of California, I took this case all the way to the Supreme Court. And now, as Secretary, I will continue to stand up and stand with you to protect access to affordable health care,” HHS Secretary Xavier Becerra said in a statement.

“We are pleased with today’s decision dismissing the challenge to the Affordable Care Act,” shared Kim Keck, president and chief executive officer of Blue Cross Blue Shield Association (BCBSA). “Today’s decision now gives the nation an opportunity to meaningfully tackle the underlying cost of health care – one of the most critical challenges in the health care system.”

"We believe the Supreme Court rightly concluded this case does not belong in court, as the challengers have not suffered any injury," Matt Eyles, president and chief executive officer of AHIP, agreed in a statement.

“ACHP is grateful that the Court has fully upheld the Affordable Care Act, an instrumental law that has significantly expanded coverage and care across America—including to more than one million people during the COVID-19 pandemic,” added Ceci Connolly, president and chief executive officer of the Alliance of Community Health Plans (ACHP).

However, in addition to the widespread relief, leaders voiced their commitment to improving the Affordable Care Act.

“Our work is far from finished,” said CMS Administrator Chiquita Brooks-LaSure, who was confirmed in May 2021. “CMS is focused on building on the successes of ACA to further expand access to health coverage.”

With regards to future cases against the Affordable Care Act, Kolber said that he is watching a district court case, Kelley v Azar, that will be decided by Judge Reed O’Connor, the same district court judge who originally found that the Affordable Care Act was unconstitutional in 2018. 

While the outcome of Kelley v Azar may not affect the ACA as a whole, it could impact a significant element of the Affordable Care Act—preventive services coverage.

The plaintiffs of this case are arguing against the Affordable Care Act’s constitutionality as they were in the California v Texas case, which means that the fact that the Supreme Court’s decision sidestepped the issue of constitutionality could be a key factor in Kelley v Azar.

Based on a decision handed down earlier in the year, Judge O’Connor seems to be favorable toward the plaintiffs who are challenging the preventive services provision, Kolber said.

Additionally, Kolber said he will also have his eye on the upcoming surprise billing regulations. He anticipated that policymaking decisions like these may progress more quickly now that the Supreme Court’s decision on California v Texas is clear.