Supreme Court Will Hear Challenge to Affordable Care Act

The U.S. Supreme Court decided to review Texas v. United States, the court case challenging the constitutionality of the Affordable Care Act (ACA). A ruling in favor of the plaintiffs would invalidate the entire law, leaving an estimated 20 million people uninsured. It is unclear how the timing will align with the November elections.


A coalition of Republican attorneys general challenged the constitutionality of the ACA in 2018. The U.S. Court of Appeals for the 5th Circuit found the individual mandate portion of the ACA unconstitutional but instead of ruling on the entire law, the Court sent the challenge back to a federal judge in Texas who previously invalidated the entirety of the ACA.

Democratic attorneys general and the Democratic-led House of Representatives, who are leading the legal defense, asked the Supreme Court to expedite a review of the case. The plaintiffs and the Trump Administration argued that this would have been premature. In January the Supreme Court announced it would not complete an expedited review of the case but on Monday, decided to take the case on a regular schedule.

What comes next?

The decision by the Supreme Court to take on the case came as a surprise to many legal experts as it is rare for them to do so when a case has not received full consideration in lower courts. The Court will begin reviewing this case in the fall when the term starts and oral arguments may come just weeks before the November general elections, but a ruling may not come until spring of 2021. Polls show that health care remains a top issue among voters and this case will become a talking point on the campaign trail.

According to an estimate by The Urban Institute, a ruling to invalidate the ACA would lead to an increase of 20 million uninsured people, a 65 percent increase in the number of non elderly people without insurance coverage. In addition to the loss of insurance coverage, many other facets of the law would be subject to elimination affecting millions living with mental illnesses and addictions and the providers who serve them.

To learn more about the background of this case and the consequences of potential repeal of the ACA, see our previous coverage in Capitol Connector. The National Council will continue to monitor the case’s progress and advocate to protect coverage for individuals seeking mental health and addiction services.