Supreme Court upholds Affordable Care Act

Key Takeaways

On June 17, the United States Supreme Court dismissed a case challenging the constitutionality of the Affordable Care Act (ACA) by a vote of 7-2. California v. Texas considered whether the individual mandate became unconstitutional when it was repealed in the Tax Cuts and Jobs Act of 2017 and, if so, whether it can be severed from the rest of the ACA. While the Court did not address these underlying questions, the justices ruled that the plaintiffs in the case – led by Texas – did not have standing to sue.

The ACA’s individual mandate required individuals to obtain health insurance or face a tax penalty. However, the Tax Cuts and Jobs Act of 2017 effectively repealed the individual mandate, reducing the tax penalty from $695 to $0. This shift led to a challenge from the state of Texas and others who argued that because the mandate was set to zero, it could no longer be considered a tax and was therefore unconstitutional. The plaintiffs further argued that if the individual mandate was unconstitutional, the rest of the ACA was. The U.S. Supreme Court ruled last week that Texas and its partners did not have the standing to bring the lawsuit forward, effectively upholding the legal grounds for the law for the third time since its passage in 2010.

County governments are key administrators of the health care safety net and are often providers of last resort for vulnerable populations who gain access to coverage under the ACA. The ACA strengthens the federal, state and local partnership for the Medicaid program and provides states with the option to expand coverage to low-income adults without children. Medicaid expansion also helps counties deliver better care for justice-involved individuals, qualifying them for access to necessary treatment and reducing the risk of recidivism. NACo will continue to work with Congress and the administration to implement and advocate for improvements to the ACA that allow counties to meet the health needs of their residents best.

Additional Resources

• NACo Press Release: NACo Responds to Supreme Court’s California v. Texas Decision
• NACo Report: Medicaid and Counties