Attempts to overturn the Affordable Care Act have struck out. The U.S. Supreme Court last week rejected the latest challenge to the 2010 law, determining that 18 states including Florida did not have standing to sue. It was the third major attempt to throw out the landmark law — and the third time the high court rebuffed those efforts. Let’s hope the game is finally over.
Republican efforts to overturn the Affordable Care Act, commonly known as Obamacare, started up as soon as the law passed more than a decade ago. In the first major test, the court in 2012 upheld the law’s individual mandate, which required most Americans to obtain health insurance or pay a tax penalty. That was crucial because of a principle known as adverse selection: Without a mandate, only the sickest people would obtain insurance, driving up the cost for everyone. Insurance pools need healthy people to participate in order to make it all work.
But in that same decision, the justices rejected the requirement that states expand their Medicaid programs to cover more people, effectively rendering the provision optional. Low-income Floridians still feel the sting of that ruling today, as Republican-controlled legislatures and Republican governors have refused to embrace the program, even though the federal government would cover 90 percent of the cost. The stimulus bill passed in March provided more money and incentives to try to woo the 12 holdout states. Florida’s leaders, in the middle of a pandemic, still refused.
The law survived another challenge in 2015 to the health insurance exchanges it established. Those are the online marketplaces where people can shop for insurance and compare plans. The challenge was weak: It claimed that the wording of the law provided subsidies for people to buy insurance on “an exchange established by the state.” Because the federal government set up exchanges for the states that refused to, the challengers tried to argue that subsidies weren’t lawful in those states. Ridiculous.
Last week, seven of the nine justices rejected a case brought during the Trump era, again attacking the individual mandate. After Congress eliminated the tax penalty attached to the mandate, 18 Republican attorneys general — including Florida’s Ashley Moody — argued that it was no longer constitutional, and thus the entire law should be struck down. The court never addressed the merits of that argument, instead saying the states as well as two individuals who sued did not show they were harmed by the law.
Consider that each case that came before the Supreme Court won by a larger majority (5-4, 6-3, 7-2, respectively), even as the court’s membership has skewed more conservative. What has always been at stake under every challenge was the health care of millions of Americans — many with pre-existing conditions that would keep them from being covered without the law’s protection. Republicans say they want to keep that provision, along with those that allow young adults to remain on their parents’ plan until age 26 and other popular features. Yet they have poured their energy into defeating the law that already does those things.
Florida made a small but significant step forward this year on helping the uninsured, lengthening Medicaid coverage for postpartum mothers to one year from the current 60 days. The move, championed by House Speaker Chris Sprowls, aims to catch the life-threatening health complications that can arise after pregnancy and reduce racial disparities in Florida’s maternal death rate. It should be the first of many more commitments to helping all Floridians have access to quality care at every stage of life, no matter their economic circumstances.
The Supreme Court’s latest ruling should end the attempts to upend the Affordable Care Act. It is embedded in our nation’s health care system, providing coverage for 33 million Americans, including nearly 2 million people in Florida, the most popular state for Obamacare. Its constitutionality is a settled question. Republicans should turn their efforts to expanding the law to get more Americans covered and give up defeating it.
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