June 16, 2021: People living with HIV and other conditions who know first-hand what it feels like to be denied insurance coverage due to preexisting conditions, as well as the millions of people who gained coverage through Medicaid expansion, can breathe a sigh of relief today. Today, the U.S. Supreme Court upheld the Affordable Care Act (ACA) by rejecting a challenge by Texas and seventeen other states to the law which risked stripping over 21 million people of health care.
The ACA was just barely upheld by the Supreme Court in 2012 because Chief Justice John Roberts found that the individual mandate, a requirement that people obtain health insurance, was an exercise of the government’s constitutional right to tax, not an unconstitutional requirement that Americans must purchase a product. In this case, California v. Texas, 18 states and two individuals argue that when Congress reduced the penalty for failing to buy health insurance to $0 in 2017, it was no longer a “tax” and therefore was an unconstitutional mandate. They also argued the individual mandate is so crucial to the ACA that the entire law is void if it is deemed unconstitutional. This comes after repeated attempts in 2017 by the Trump administration and Congress to repeal the ACA failed and which culminated in the change in the penalty.
This lawsuit was a cynical strategy to get the courts to do what Congress would not: deny health care to tens of millions of Americans made vulnerable by preexisting health conditions and/or low incomes. You can find a detailed accounting of how this case ended up before the Supreme Court here.
Positive Women’s Network – USA (PWN) is deeply relieved that the Supreme Court unequivocally made the right decision in ruling that the plaintiffs in the original case—the attorney general of Texas, the other state attorneys general who joined the case, and two individuals—lacked standing to bring the case. A verdict even narrowly or partially in favor of the Texas attorney general would have literally endangered the health, well-being, and even survival of the hundreds of thousands of people living with HIV who have gained comprehensive health coverage through Medicaid expansion, protections against sex discrimination, a term which the Biden administration has deemed is inclusive of gender identity and sexual orientation, and/or the protections for preexisting conditions included in the ACA.
Still, the fact that this lawsuit even made it to the Supreme Court—which is now more ideologically tilted than at any time in recent history—is profoundly disturbing and shows how fragile progress is, even when—especially when—it benefits the most vulnerable. And while the ACA concretely improved the lives and health of so many—the Center for Budget and Policy Priorities estimates that Medicaid expansion alone had saved over 19,000 lives of low-income adults between 2014 and 2017—it still does not go far enough. Since state governments can choose whether or not to expand Medicaid, far too many low-income people living with HIV in non-expansion states remain uninsured and have to rely on Ryan White programs and ADAP for their medications—if they manage to stay in care at all. Furthermore, the ACA’s insurance marketplace, despite hefty government subsidies that make plans much more affordable to many, has not reduced the outrageous price tags on prescription medications, treatments, and medical services that have bankrupted so many and that lead to the U.S. spending more on health care than any other nation without guaranteeing coverage to all its residents or even ensuring quality of care. Insurance companies are still reaping huge profits while denying coverage for necessary medications, treatments, and procedures.
PWN has always advocated for and continues to push for universal health care as one of our policy priorities, including the Medicare for All Act of 2021, H.R. 1976. All other developed nations guarantee health care for all their citizens through a variety of different models. While there are benefits and drawbacks to each model, the fundamental principle is the same: All people deserve access to health care as a human right. Today’s Supreme Court decision gives us some breathing room, but it does not solve the long-term problem. Until the U.S. adopts a health care system that recognizes health care as a right and ensures that everyone can get the care they need, when they need it, regardless of health conditions, personal finances, geographic location, race, gender, or immigration status, PWN will never stop fighting.
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