ACA legality case has first encounter with Supreme Court: 6 takeaways

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The U.S. Supreme Court heard the first arguments Nov. 10 in a case questioning the legality of the ACA.

Six things to know:

1. In California v. Texas, a coalition of Republican-leaning states, led by Texas and backed by the Trump administration, argue the entire ACA is invalid because in December 2017, Congress eliminated the ACA's tax penalty for failing to purchase health insurance. The states argue the individual mandate requiring Americans to gain health insurance or pay a penalty is inseverable from the rest of the law and became unconstitutional when the tax penalty was eliminated; therefore, the entire health law should be struck down.

2. California Attorney General Xavier Becerra is leading a coalition of more Democratic states to defend the ACA before the Supreme Court. The coalition argues the individual mandate leaves the decision of whether to carry insurance up to individual Americans, but even if eliminating the penalty makes the insurance requirement unconstitutional, the entire health law should not be struck down, and protections for preexisting conditions should remain intact, according to The Wall Street Journal.

3. The Republican officials brought their challenge to U.S. District Judge Reed O'Connor, with the Northern District of Texas, who ruled the ACA unconstitutional. Subsequently, in December 2019, the 5th Circuit Court of Appeals ruled the ACA's individual mandate is unconstitutional, but did not issue a decision on whether the entire law is therefore unconstitutional. Instead, the 5th Circuit sent that decision back to the Northern District of Texas to determine which portions of the ACA are inseverable from the individual mandate. The coalition led by Mr. Becerra filed a petition to the U.S. Supreme Court seeking review of the 5th Circuit's decision, which was granted by the Supreme Court in March.

4. On Nov. 10, at least five Supreme Court justices indicated support for not striking down the entire ACA, according to The New York Times. The publication reported that Chief Justice John Roberts Jr. and Justice Brett Kavanaugh suggested striking down the individual mandate did not require striking down the rest of the law. "It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the act in place, the provisions regarding preexisting conditions and the rest," Justice Kavanaugh said, according to the Times and Journal.

5. According to the Times, Justices Stephen Breyer, Sonia Sotomayor and Elena Kagan also indicated they backed the ACA. The Journal reported that Justice Kagan noted the Supreme Court previously upheld the individual mandate when the penalty was several hundred dollars and said: "The only thing that's changed is something that made the law less coercive."

5. Justices Clarence Thomas, Samuel Alito Jr. and Neil Gorsuch appeared more likely to side with the argument from Republican officials, according to the Times, while Justice Amy Coney Barrett did not indicate a clear stance.

6. According to the Times, the Supreme Court is not expected to decide the case until June.

Read the full Times report here and the full Journal report here.  

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