On Thursday, June 17, 2021, the U.S. Supreme Court rejected a challenge in California v. Texas, led by the state of Texas, to the constitutionality of the ACA. The strong 7 to 2 vote rejected the standing of the states to bring the case but also rejected several arguments made to strike down the entire ACA because of the burden some states claimed. Texas (along with over a dozen states and two individuals) brought the suit claiming that without the tax penalty (reduced to zero by Congress), the Act’s minimum essential coverage provision, codified at 26 U. S. C. §5000A(a), is unconstitutional.


This is the third time the Supreme Court has rejected efforts to rule the ACA unconstitutional. The Court majority rejected claims of harm by the states and the two official plaintiffs. In 2019, the U.S. Fifth Circuit of Appeals agreed with Judge Reed O’Connor of the Federal District Court in Fort Worth when he ruled that “the keystone” of the law was the individual mandate and, when Congress zeroed out the individual mandate tax penalty, that that meant the law failed to be constitutional. Congress zeroed out the tax as part of the December 2017 tax cut package. 


Justice Stephen Breyer wrote the majority opinion, and he was joined by Chief Justice Roberts, Justice Thomas, Justice Sotomayor, Justice Kagan Justice Kavanaugh, and Justice Barrett Justice Alito filed a dissenting opinion which Justice Gorsuch signed.


“The state plaintiffs allege indirect injury in the form of increased costs to run state-operated medical insurance programs. They say the minimum essential coverage provision has caused more state residents to enroll in the programs. The States, like the individual plaintiffs, have failed to show how that alleged harm is traceable to the Government’s [essential benefits]… But the States have also not shown that the challenged minimum essential coverage provision, without any prospect of penalty, will injure them by leading more individuals to enroll in these programs. …The other asserted pocketbook injuries related to the Act are similarly the result of enforcement of provisions of the Act that operate independently of [essential package of benefits]. No one claims these other provisions violate the Constitution.”


The strong majority with an even bigger conservative majority now on the Court should put a stop to further legal attacks, but that is uncertain as long as the continuing attacks can raise political passions.