As the Affordable Care Act Turns 10, Will the Supreme Court Save the Day Again?

                                                                                                                    High Court to Consider Intervening in Texas Case that Would Gut ACA 
NEW YORK, NY—February 18, 2020—As the Affordable Care Act (ACA) approaches its tenth anniversary, federal court decisions in a case brought by Texas and 17 other states, if allowed to stand, would increase the number of uninsured by nearly 20 million people—about 75 percent Medicaid and Child Health Plus enrollees—and likely wreak havoc on health insurance coverage, financing, and consumer protections across the nation, according to a new report released today by United Hospital Fund (UHF).

On February 21 the U.S. Supreme Court is slated to meet to consider whether to intervene in the case, which revolves around a federal district court decision that the individual mandate provisions are unconstitutional and so the entire ACA must be voided (even though the mandated tax penalty was eliminated in 2017). Besides eliminating insurance for millions, striking down the ACA would do away with a long list of consumer protections, including mandated coverage of pre-existing medical conditions, comprehensive coverage, free preventive care, coverage for children up to age 26 through their parents’ plans, equal premium rates for men and women, caps on premiums for older people, bans on annual and lifetime dollar limits, caps on out of-pocket expenses, and efforts to improve health care quality and reduce costs. In addition, federal spending on health care would be cut by almost $135 billion. 
“Currently most of the focus of the impact of potential ACA repeal has been on coverage for pre-existing conditions, a very valid concern, but the range of consumer protections that would be swept away would affect virtually every aspect of health insurance, even in New York, with its active, pro-consumer regulators,” said Peter Newell, director of UHF’s Health Insurance Project and author of the report. “The loss of $10-$13 billion in federal financing for New York would also cripple the state’s Medicaid program, reverse individual market gains, and bring an end to the Essential Plan, the state’s Basic Health Program option, one of the nation’s best experiments at covering low-income workers.” 

The lawsuit against the ACA was first filed in 2018, with a coalition of state attorneys general (including New York’s) stepping up when the U.S. Department of Justice refused to defend the ACA. A lower court judge sided with Texas in December 2018, striking down the entire law. This past December a federal appeals court agreed on the individual mandate question but asked the lower court to take a “finer tooth comb” to the law to determine what parts, if any, could stand. However, the state attorneys general seeking to preserve the law and the U.S. House of Representatives convinced the Supreme Court to consider the case. 
The UHF report notes that, just as the effects of the ACA vary state by state, so too would the impact of its repeal, depending on a state’s coverage and regulatory landscape prior to the law’s passage in 2010. New York had many of the ACA provisions already in place, such as protection against denying coverage or charging high rates to individuals with pre-existing conditions. However, state insurance regulation is limited to fully insured plans, so only about half of the nine million New Yorkers with job-based coverage are subject to state consumer protections. Decisions on whether to provide free preventive care for children or cover children on workers’ policies would be up to employers for the rest. Also, the loss of $600 million in tax credits would likely destabilize the individual market, returning it to its previous dysfunctional state, the report said.  

At the conference scheduled for February 21, the Court could put the case on track for a decision by June, push it back until after the November elections, or let the matter play out in the lower courts. 

The report, Deliver Us from Texas: As the ACA Turns 10, Will the Supreme Court Step Up Again?, can be downloaded from UHF’s website. 

 About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at and follow us on Twitter


Feb. 18, 2020
Focus Area
Coverage and Access
Health Insurance Project