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The case is the result of a 2018 lawsuit filed by 20 Republican-led states, including Texas, seeking to have the entire ACA struck down. 

The future of the Affordable Care Act (ACA), which helped millions of Americans obtain life-saving healthcare coverage, once again lies with the U.S. Supreme Court. 

The Court announced Monday it will hear a third challenge to the groundbreaking 2010 healthcare law, this time in a case brought by Democratic-controlled states fighting to overturn a lower court decision that ruled the ACA was unconstitutional. 

The court’s review is expected to come in its fall term, starting in October, meaning a decision will not be issued prior to the November election. 

The law remains in effect for now.  but here’s what could happen if the Supreme Court strikes down the ACA:

  • Nearly 20 million Americans could lose their coverage, which would increase the country’s uninsured rate by 65%. 
  • As many as 129 million Americans live with pre-existing conditions and may lose protections guaranteed by the ACA. Nearly 54 million of these Americans would likely be uninsurable in the individual market without the ACA.
  • Women could once again be forced to pay higher premiums than men. 
  • Seniors could end up paying more for prescription drugs.

While millions of Americans may end up losing coverage and others see their costs under ACA repeal go up, a select group would stand to benefit from such a ruling. A November 2019 study from the Center on Budget and Policy Priorities found that “striking down the ACA would cut taxes sharply for the highest-income Americans and certain corporations.”

House Speaker Nancy Pelosi released a statement on Monday about the Court’s decision to take up the case, calling the law “an essential pillar of health and financial security,” and added that “[t]he sooner the GOP’s dangerous anti-health care lawsuit is ended, the better.”

Wait, how did we get here?

The case is the result of a 2018 lawsuit filed by 20 Republican-led states, including Texas, seeking to have the entire ACA struck down. Two states, Wisconsin and Maine, have since withdrawn from the case, leaving 18 states to challenge the ACA’s constitutionality. 

Republicans quickly gained momentum in their efforts, when a federal district court in Texas invalidated the entire ACA in December 2018, a ruling that was immediately appealed by 21 Democratic states, led by California. 

The federal government traditionally defends existing federal laws, but the Trump administration announced in March 2019 that it was siding with Republican states, agreeing that the entire law should be struck down. 

The U.S. Court of Appeals for the 5th Circuit heard the appeal and ultimately ruled in December 2019 that the ACA’s individual mandate was unconstitutional, but sent the case back to the district court to determine whether the rest of the law could stand without it. 

The House of Representatives and Democratic-states have pushed to get the issue to the Supreme Court because the five-justice majority that previously upheld the ACA twice remains on the bench. The court previously rejected a motion from the Democratic-led states and the House of Representatives to fast-track the appeal and hear the case this term. 

The Democratic coalition then asked the court to hear their appeal on a standard timeline, saying the lower courts’ rulings created uncertainty about the law, which could affect individuals, businesses, and local governments. 

“Each year, for example, millions of Americans make life-changing decisions—like starting a family or changing jobs—in reliance on the ACA’s patient protections and the greater access to affordable healthcare coverage it provides,” lawyers for the democratic states wrote. “Prolonged uncertainty about whether or to what extent important provisions of the ACA might be invalidated makes these choices more difficult, threatening adverse consequences for American families, healthcare markets, and the broader economy.”

The Trump administration asked the Court to deny the review, saying that “immediate review is unwarranted” since the lower court had not yet issued a final ruling on which parts of the law should survive.

The Court’s ruling is expected to come in the spring or summer of 2021.