The Constitutionality of the Affordable Care Act

By: Nicole Nazari

There is something disturbingly wrong with the American health care system. Before 2014, when the Patient Protection and Affordable Care Act (ACA) took effect, individual market insurers could conduct a litany of unethical practices. Insurers could deny coverage to applicants with preexisting conditions, charge sicker people higher premiums, and not cover specific benefits such as mental health treatment. [1] About 46.5 million Americans (17.8%) were unable to be approved for health insurance and were left without coverage. [2] The ACA, however, included a multitude of provisions to increase access to health insurance, health care costs, and delivery of care. The number of uninsured nonelderly dropped below 27 million people (10%). [2] Despite the lives saved, the ACA’s individual mandate has been held hostage in numerous legal battles.

The individual mandate, the most controversial provision of the ACA, was meant to increase coverage. The individual mandate required Americans to purchase health insurance or face a government penalty. [3] The purpose of the penalty, or “tax,” was to incentivize healthy individuals to pay into the system to counterbalance the healthcare costs of the sick.

However, in 2017, Congress passed the Tax Cuts and Jobs Act. The legislation made the tax penalty zero dollars, effective January 1, 2019. [1] Consequently, 18 state attorney generals filed a suit against the ACA in Texas v. United States. The health reform bill did not have a clause that would declare the rest of the law “severable” should any provision be invalidated by the courts on constitutional grounds. [4] A federal district court judge thereby ruled that since Congress invalidated the individual mandate, then all of the ACA must be invalid too. [5]

Opponents of the judge’s reasoning suggested that because Congress only made the penalty zero dollars without eliminating the rest of the ACA, that congressional intent was to protect all other provisions of the ACA. [4] If the Fifth Circuit upholds the district court’s decision, the Supreme Court will be forced to hear this case. If heard, this will be the fourth time the Court has granted certiorari to determine the legality of the ACA. The ACA has already withstood more than 70 unsuccessful repeal attempts. [6]

It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The ACA includes provisions that not only affect pre-existing conditions, but Medicare and Medicaid, generic biologic drugs, free birth control, the Indian Health Service, and public health changes like calorie counts on menus. [6] Because of the ACA, people are no longer declined health insurance for having type 1 (early onset) diabetes. Because of the ACA, recent college graduates who just started their career are no longer forced to buy their own insurance. Because of the ACA, hard-working individuals living below the poverty level are no longer forced to neglect or decline treatment. The real life stories of families are endless. [7] The unknown future of the ACA leaves the American people, yet again, desperately awaiting a solution that has a direct effect on their lives.

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