– With the U.S. Supreme Court’s rejection of the latest challenge to Obamacare, the president’s five-year-old healthcare law may have attained something it has previously lacked: permanence.
While litigation seeking to upend the statute remains, and more will likely be filed, no current lawsuit is seen by supporters or opponents as an existential threat.
“The real threats to the Affordable Care Act are largely behind us,” said Ron Pollack, executive director of Families USA, a health-care advocacy group. David Rivkin, a Washington lawyer who represented opponents of the law, agreed, saying there aren’t any “fundamental challenges” left.
On the horizon however is the possibility that Republicans, who have opposed the law from the start, capture the White House and retain control of Congress. Then President Barack Obama’s seminal legislative achievement may again be at risk.
The 2010 Patient Protection and Affordable Care Act has weathered more than 50 votes for delay or repeal in the Republican-led U.S. House of Representatives, as well as a Florida-led 26-state assault in the federal courts.
Obama signed the legislation with the objective of making health insurance nearly universal in the U.S. To achieve that, it required people obtain coverage, barred insurers from rejecting applicants for pre-existing medical conditions, offered states money to expand their Medicaid eligibility, and made tax breaks available to people who signed up on online marketplaces known as exchanges.
Yet most states declined to set up exchanges, leaving that task to the federal government. And many refused the offer to expand Medicaid after the Supreme Court said in an earlier case that they couldn’t be compelled to accept the extra money.
The act’s opponents have scored few victories, aside from one for private businesses run on religious principles. They won the right to ignore the law’s requirement that they provide contraception coverage.
In the decision announced Thursday, the high court rejected a lawsuit by Virginia residents. They cited a passage in the law which they argued limited tax subsidies to those who obtain insurance on state-established exchanges. Had the challengers prevailed, residents of the 34 states that didn’t set up online marketplaces would have lost access to subsidies, leaving many unable to afford their policies.
Though none is seen as life threatening, more litigation is nevertheless in store for the law.
“We have a long, complicated statute that implicates a significant portion of the economy,” said Jonathan Adler, a law professor at Case Western University in Cleveland. “The law was poorly written and enacted in a rush.”
“We’re going to see ACA suits forever,” Adler said, adding that while major challenges may be past, “there will continue to be significant cases about the way the law is implemented.”
One such battle is already before a federal judge in Washington. House Republicans contend that U.S. reimbursements to insurance companies, expected to tally about $175 billion over a decade, weren’t approved by Congress, and that Obama unlawfully delayed by a year a requirement that most employers offer insurance to their workers.
Obama administration attorneys on May 28 asked U.S. District Judge Rosemary Collyer to dismiss the suit, arguing the issues are political and should be resolved in Congress. She has yet to rule.
Timothy Jost, a law professor at Washington & Lee University in Lexington, Virginia, said a decision to strike down those reimbursements wouldn’t extinguish the law, but may force insurance carriers to raise rates.
Indiana and dozens of its school districts sued in 2013 over an aspect of the law’s employer coverage mandate. At issue is a requirement that companies provide coverage to any employee who works more than 30 hours a week or pay a penalty, as well as the tax subsidy at issue in Thursdays Supreme Court ruling, claiming these violate state sovereign rights.
An Indianapolis federal judge who heard the arguments put his ruling on hold pending the outcome of the high court case.
Jost said even if Republicans capture the White House next year, the prospect of outright repeal is unlikely. He said the legislation is now so interwoven with the U.S. healthcare industry that “it would be like repealing the interstate highway system.”
Jost sentiments were supported by healthcare stocks, which jumped as much as 8 percent on the Supreme Court ruling.
Still, the law could be significantly amended to limit its effectiveness and reach, Jost said.