We don’t yet know the outcome of Tuesday’s big U.S. Supreme Court hearing on a case aimed at dismantling the Affordable Care Act. But anyone who relies upon the Obama-era law’s protections can probably breathe at least a provisional sigh of relief based on the justices’ questioning.
Texas’ Republican attorney general and a bunch of his ideological allies — including Louisiana Attorney General Jeff Landry and the Trump administration — based their challenge on a tax law that the GOP-controlled Congress adopted in 2017. That eliminated the penalty on those who don’t comply with the ACA’s mandate to carry health insurance.
Because a prior high court decision upholding the law relied upon the government’s taxing authority, the legal theory goes, the mandate is now unconstitutional. A far more tenuous companion argument is that the entire law must therefore fall, even though the same Congress that passed the tax cut had failed to overturn the health care law as a whole.
If the court were to buy that line of reasoning, millions of Americans would suffer. Much of the political debate over the case has focused on the loss of protections for people with preexisting conditions, who would no longer be guaranteed access to coverage at rates available to the general public. But overturning the ACA would also end the Medicaid expansion that now provides insurance to 562,383 Louisianans. And it would rob patients of essential benefits the law requires plans to include, from emergency care to mental health treatment to pregnancy coverage.
The good news for patients here and around the country is that such an outcome appears unlikely. Despite a newly-entrenched conservative 6-3 majority, key justices raised basic, logical questions during the hearing. Chief Justice John Roberts pointed out that Congress left the rest of the law intact when it zeroed out the penalty, which he said makes it hard to suggest that the legislative intent was to see it die. Justice Brett Kavanaugh said the case for severability — or for invalidating the challenged aspect of the law without throwing out unrelated parts — appeared “very straightforward” under court precedent.
Even Justice Samuel Alito noted that other parts of the law are working as planned even without the penalties. If conservatives can’t lock Alito down, they’re looking at a rout.
We’ll have to wait to see if that happens, but we don’t need to wait to judge Landry’s decision to put Louisiana’s name behind a farfetched ideological crusade that might burnish his own bona fides, but would hurt his constituents.
As the conservative justices’ reception suggests, this case is fundamentally unserious. And that says something about the people who are pushing it.