What to know as ACA lawsuit is argued in Supreme Court

The Supreme Court heard oral arguments Tuesday "in a case that, for the third time in eight years, could result in the justices striking down the Affordable Care Act," Julie Rovner reports for Kaiser Health News. However, initial reporting on the oral arguments indicates that the court is unlikely to do that.

"The case, California v. Texas, is the result of a change to the health law made by Congress in 2017. As part of a major tax bill, Congress reduced to zero the penalty for not having health insurance. But it was that penalty — a tax — that the high court ruled made the law constitutional in a 2012 decision, argues a group of Republican state attorneys general. Without the tax, they say in their suit, the rest of the law must fall, too."

The court could rule in a number of ways, Rovner notes: It could declare the whole law unconstitutional, refuse to decide the case on the grounds that the plaintiffs don't have the legal standing to sue; rule that, by eliminating the penalty but not the rest of the mandate, lawmakers didn't intend to coerce citizens, so there's no constitutional conflict; or that, without the tax, the requirement to have health insurance is unconstitutional but the rest of the law is legally sound.

Many rural conservatives dislike the ACA because they insist that the open-market premiums are too expensive. But some aspects are popular, including Medicaid expansion in many states and protections for pre-existing conditions and a requirement that insurers provide coverage to everyone who wants it. "But throughout the attempts to eliminate the ACA, politicians who oppose the law have promised that people with preexisting conditions will still be able to access health insurance if the law is overturned," Lauren Peace reports for Mountain State Spotlight. "But that’s easier said than done."

In West Virginia, for example, more than a third of the state's people under 65 have medical conditions that would have made it difficult to get affordable private insurance before the ACA, Peace reports. Patrick Morrisey one of the attorneys general pressing the case, won re-election last week over a Democratic challenger who supported preserving the ACA. Morrisey has not yet proposed a plan to replace the Medicaid money and other federal dollars the law brings into the state, but promised in a January 2020 interview with MetroNews that, should the ACA be overturned, "people will be protected if they have pre-existing conditions."

In essence, "The ACA offers three tiers of protections. Preventing the denial of coverage is just one," Peace reports. "But requiring insurance companies to cover everyone regardless of medical history doesn’t mean by itself that coverage will be affordable, or prevent insurers from charging some people more if they have conditions that are expensive to treat."