Supreme Court Upholds Obamacare Act, with Gorsuch and Alito Dissenting

The U.S. Supreme Court upheld the Obamacare act and dismissed a challenge to its law on Thursday, with Justices Samuel Alito and Neil Gorsuch dissenting.

The court ruled the challenge by Republican-led states of Texas and others alongside two individuals did not belong in federal court. The move protects healthcare insurance for millions of U.S. citizens.

Justice Stephen Breyer wrote that those who filed the lawsuit against the law, also known as the Affordable Care Act, "have failed to show that they have standing to attack as unconstitutional the Act's minimum essential coverage provision."

Justice Gorsuch is one of Trump's appointees to the court alongside Justices Amy Coney Barrett and Brett Kavanaugh. Both Barrett and Kavanaugh supported dismissing the challenge in the 7-2 vote. The health insurance of 31 million Americans is covered under the Obama era-law according to President Joe Biden's administration.

For more reporting from the Associated Press, see below:

The Supreme Court turned aside an effort by Republican-led states to throw out the law that provides insurance coverage for many Americans.

The law's major provisions include protections for people with pre-existing health conditions, a range of no-cost preventive services and the expansion of the Medicaid program that insures lower-income people, including those who work in jobs that don't pay much or provide health insurance.

The elimination of the penalty had become the hook that Texas and other Republican-led states, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law should fall, too.

And with a more conservative Supreme Court that includes three Trump appointees, opponents of Obamacare hoped a majority of the justices would finally kill off the law they have been fighting against for more than a decade.

But the third major attack on the law at the Supreme Court ended the way the first two did, with a majority of the court rebuffing efforts to gut the law or get rid of it altogether.

Gorsuch was in dissent, signing on to an opinion from Justice Samuel Alito.

In dissent, Alito wrote, "Today's decision is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue." Alito was a dissenter in the two earlier cases, as well.

Like Alito, Justice Clarence Thomas was in dissent in the two earlier cases, but he joined Thursday's majority, writing, "Although this Court has erred twice before in cases involving the Affordable Care Act, it does not err today."

Because it dismissed the case for the plaintiff's lack of legal standing—the ability to sue—the court didn't actually rule on whether the individual mandate is unconstitutional now that there is no penalty for forgoing insurance. Lower courts had struck down the mandate, in rulings that were wiped away by the Supreme Court decision.

With the latest ruling, the ACA is "here to stay for the foreseeable future," said Larry Levitt, an executive vice president for the non-profit Kaiser Family Foundation, which studies health care.

"Democrats are in charge and they have made reinvigorating and building on the ACA a key priority," Levitt said. "Republicans don't seem to have much enthusiasm for continuing to try to overturn the law."

Republicans pressed their argument to invalidate the whole law even though congressional efforts to rip out the entire law "root and branch," in Senate GOP Leader Mitch McConnell's words, have failed. The closest they came was in July 2017 when Arizona Sen. John McCain, who died the following year, delivered a dramatic thumbs-down vote to a repeal effort by fellow Republicans.

Chief Justice John Roberts said during arguments in November that it seemed the law's foes were asking the court to do work best left to the political branches of government.

The court's decision preserves benefits that became part of the fabric of the nation's health care system.

Polls show the 2010 health care law grew in popularity as it endured the heaviest assault. In December 2016, just before Obama left office and Trump swept in calling the ACA a "disaster," 46 percent of Americans had an unfavorable view of the law, while 43 percent approved, according to the Kaiser Family Foundation tracking poll. Those ratings flipped and by February of this year 54 percent had a favorable view, while disapproval had fallen to 39 percent in the same ongoing poll.

The health law is now undergoing an expansion under President Joe Biden, who sees it as the foundation for moving the U.S. to coverage for all. His giant COVID-19 relief bill significantly increased subsidies for private health plans offered through the ACA's insurance markets, while also dangling higher federal payments before the dozen states that have declined the law's Medicaid expansion. About 1 million people have signed up with HealthCare.gov since Biden reopened enrollment amid high levels of COVID cases earlier this year.

Most of the people with insurance because of the law have it through Medicaid expansion or the health insurance markets that offer subsidized private plans. But its most popular benefit is protection for people with pre-existing medical conditions. They cannot be turned down for coverage on account of health problems, or charged a higher premium. While those covered under employer plans already had such protections, "Obamacare" guaranteed them for people buying individual policies.

Another hugely popular benefit allowed young adults to remain on their parents' health insurance until they turn 26. Before the law, going without medical coverage was akin to a rite of passage for people in their 20's getting a start in the world.

Because of the ACA, most privately insured women receive birth control free of charge. It's considered a preventive benefit covered at no additional cost to the patient. So are routine screenings for cancer and other conditions.

For Medicare recipients, "Obamacare" also improved preventive care, and more importantly, closed a prescription drug coverage gap of several thousand dollars that was known as the "doughnut hole."