Healthcare officials are also concerned that the focus on the fate of the healthcare law before the court may dissuade some Americans from enrolling in health coverage on insurance marketplaces such as Covered California. Open enrollment on Covered California and the federal HealthCare. When congressional Democrats and the Obama administration were crafting the healthcare law, they and many experts argued that a mandate requiring Americans to get health insurance was critical to ensuring the law and its protections for people with preexisting conditions would function.
But as time has passed, it has become increasingly clear this is not the case, undermining a central argument being made by the Trump administration, Texas and the other Republican-led states seeking to invalidate the law.
Despite the elimination of the penalty for not having insurance, insurance marketplaces have not collapsed. In fact, enrollment has remained steady, as have premiums. Senior Trump administration officials — including Seema Verma, who oversees Medicare, Medicaid and the marketplaces — and government lawyers have repeatedly hailed the stability of the marketplaces in recent years, noting enrollment and premium numbers.
David G. Former staff writer Noam N. Levey covered national healthcare policy out of Washington, D. A former investigative and political reporter, he is a Boston native and a graduate of Princeton University. He joined the newspaper in and reported from Washington from to History-making lieutenant governor ready to work in Virginia. Trump ally Stephen Bannon indicted on contempt charges over Capitol riot inquiry. Biden and Xi to hold virtual summit Monday to discuss tensions.
Last December, a US district court judge agreed with the Republican challengers and ruled that because the tax penalty is now zero, the entire health care law is unconstitutional. That panel is not expected to rule for several months. When it does, the case of Texas v. United States is likely bound for the Supreme Court where, despite recent changes among the nine, the majority that previously upheld the law -- Roberts and four liberal justices -- is still there.
Switch by Trump administration. This new case could be the most consequential test of Obamacare yet.
Millions of Americans now obtain their health insurance through the ACA-created exchanges or Medicaid expansion. Among the law's provisions, people with cancer, diabetes or other pre-existing conditions cannot be refused coverage and children can stay on their parents' health insurance plans until they turn Republican-appointed judges appear to side with Texas challenge to Obamacare.
The Trump administration initially argued that, based on the tax law change, only the individual mandate and two related provisions tied to protections for people pre-existing health conditions should be invalidated. But now its Justice Department is agreeing with Texas that the entire law should be struck down because, they insist, the law's many provisions are intertwined. If one is unconstitutional, so is the rest, they say -- a ruling that if upheld could give Trump the result of killing Obamacare that he couldn't accomplish with a GOP-controlled Congress in Roberts' moves behind the scenes were as extraordinary as his ruling.
He changed course multiple times. He was part of the majority of justices who initially voted in a private conference to strike down the individual insurance mandate -- the heart of the law -- but he also voted to uphold an expansion of Medicaid for people near the poverty line.
Two months later, Roberts had shifted on both. The final tallies, to uphold the individual mandate and to curtail the Medicaid plan , came after weeks of negotiations and trade-offs among the justices. The ACA, signed by Obama in , followed decades of failed attempts in Washington to control spiraling medical costs and provide Americans with higher-quality health care. It created a marketplace where the uninsured could buy coverage and protected people from being unable to get health insurance because of pre-existing conditions such as diabetes, cancer and other chronic illnesses.
To support the system and draw in the healthy as well as the sick, the law required that most uninsured people obtain coverage the "individual mandate" or pay a penalty, to be collected as part of an individual's annual taxes -- a provision critical to the final ruling. The law also expanded Medicaid benefits to a wider range of needy individuals.
But it would come with a strict condition: If states did not broaden their programs as dictated they would lose all Medicaid funds.
The first meeting -- against the mandate. After an unusual three full days of oral arguments in late March a typical case gets one hour on one day , the nine justices gathered in a private conference room off the chief's chambers to cast initial votes. They were alone, with no law clerks or administrative staff. The discussion focused on the individual insurance mandate and Congress' power to regulate commerce.
Roberts went first, as was the custom, laying out his views. He emphasized that he believed the Constitution's commerce clause never was intended to cover inactivity, such as the refusal to buy insurance. Like Roberts, they thought Congress' commerce authority did not cover an individual's decision to forgo -- rather than obtain -- health insurance. There were thus four immediate votes cast to invalidate the mandate.
No one at the table was surprised, based on the questions during oral arguments and word from law clerks inside the building circulating intelligence among the justices' chambers.
Photos: Chief Justice John Roberts. Hide Caption. Roberts is seen in a yearbook photo from his prep school in La Porte, Indiana. He was born in Buffalo but grew up in northwest Indiana. In , he graduated from Harvard Law School. He was an associate counsel to Reagan from As an attorney for the government and in 14 years of private practice, Roberts argued 39 cases before the Supreme Court and won 25 of them. In May , President George W. Roberts is seen at right along with Bush's other judicial appointments.
Roberts, third from left, meets with US senators in Washington a day after he was nominated by Bush. With Roberts, from left, are Sens. Roberts meets with US Sen. Mary Landrieu as he makes his rounds on Capitol Hill in July Bush announced that he wanted Roberts to replace Rehnquist instead. Roberts was once a law clerk for Rehnquist. Roberts answers questions during his second day of confirmation hearings in September Read: The GOP is suddenly playing defense on healthcare.
Undoubtedly, Madison was a great statesman, but he was also a politician perfectly willing to shed principles for expediency. And after opposing the first bank in Congress in , Madison advocated for the second bank as president in Before Roberts resurrected it in , it had not entered American constitutional jurisprudence.
And if the draft can be implied, surely the individual mandate can be, too. The Texas decision can easily be overturned, and Obamacare upheld, without Roberts revisiting his ill-fated choice of Madison over Marshall.
But the Texas case highlights just why he should have sided with the long-standing precedent set by the Great Chief Justice, not the twice-rejected, eccentric argument of a flip-flopping congressman.
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