Despite having a GOP-controlled House and Senate during the first two years of Donald Trump’s presidency, along with overwhelming Republican support to repeal the federal statute, the Affordable Care Act (ACA) has remained largely intact.
The health insurance law survived its third major challenge over the last decade after the Supreme Court threw out the latest effort by 18 Republican-led states to kill the ACA Thursday.
In a dissenting opinion Justice Samuel Alito called the 7-2 decision to preserve the law “the third installment in our epic Affordable Care Act trilogy.”
Thursday’s ruling shot down Republican attempts to argue that the ACA was no longer constitutional after the individual mandate was eradicated in 2017 – removing any penalties issued to Americans who chose not to pay for health insurance.
The decision was reached after the states failed to show they were negatively impacted by a mandate that had been rendered ineffective, the High Court said.
The ACA has seen a spike in support according to a 2021 poll, but its popularity has wildly fluctuated over the last decade.
A Kaiser Family Foundation (KFF) tracking poll released in May found that 53 percent of Americans support the ACA while 35 percent disapprove of the law — a significant jump from its 46 percent approval rating in April 2010.
By 2011 support for the healthcare law had dropped, with half of all Americans saying they viewed the ACA “unfavorably.”
In November 2011, the Supreme Court agreed to hear its first round of arguments brought forward by 26 states and the National Federation of Independent Business.
The arguments were the first push by the GOP to contest the constitutionality of the individual mandate.
The Supreme Court upheld the ACA and the individual mandate in June 2012.
The high court again heard oral arguments in March 2015, challenging how subsidies could be distributed through U.S. Treasury regulation.
The court upheld the ACA subsidy system in June 2015 in a 6-3 vote, ruling subsidies could be provided through a federal program if a state did not set up its own exchange.
In late 2015, Republicans passed the Restoring Americans’ Healthcare Freedom Reconciliation Act — which would have repealed several aspects of the ACA. But Obama vetoed the act on Jan. 8, 2016.
Support for the ACA dropped during Obama’s presidency, with the majority of Americans saying they disapproved of the federal statute by the time Donald Trump entered office.
The Republican Party ran in 2016 on the pledge to “repeal and replace” the national healthcare system.
Following a successful campaign, Mike Pence said, “President-elect Donald Trump will prioritize repealing President Barack Obama’s landmark health care law right ‘out of the gate’ once he takes office.”
But even after Obama left the Oval Office, the GOP was never able to “repeal and replace” the federal statute.
Trump secured a GOP win by signing the Tax Cuts and Jobs Act in 2017, which eliminated the contested federal tax penalty issued for violating the individual mandate provision.
But the Republican Party faced opposition from within after they were unable to successfully draft a plan for the “replace” part of the deal that helped land Trump the keys to the White House.
Despite several votes to repeal the ACA during the Obama administration, some GOP senators refused to repeal the act without a backup plan while they led the executive and legislative branches of the government.
It was in this context that the late Arizona Sen. John McCain delivered his notorious thumbs down on perhaps the best and last chance the GOP would have to repeal the legislation.
Despite pressure from Senate Majority Leader Mitch McConnell, McCain, along with Senators Susan Collins of Maine and Lisa Murkowski of Alaska, voted against the 2017 Health Care Freedom Act – which would have prohibited health insurers from accepting federal subsidies under the ACA.
“From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people,” McCain said in a statement following the controversial move. “While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens.”
In 2017 support for the ACA reversed and reached a record high 55 percent “favorable” rating by February 2020.
Some hailed the Supreme Court ruling Thursday as a win that will secure the future of the healthcare law.
“The Affordable Care Act remains the law of the land,” President Biden said following the decision. “Today’s U.S. Supreme Court decision is a major victory for all Americans benefiting from this groundbreaking and life-changing law.”
Now, Biden has said he intends to expand it.
But Republican legal officials criticized the Thursday Supreme Court ruling – pledging to keep fighting against the ACA.
West Virginia Attorney General Patrick Morrisey said in a statement to Fox News that he was “deeply disappointed that the court ducked the question about the unconstitutionality of the individual mandate.
“This case was always about: one, ensuring that individuals could not be coerced into purchasing health insurance against their will; and, two, making the insurance system far more affordable for hard-working Americans,” Morrisey said. “We will keep fighting for affordable coverage and against coercive, individual mandates that represent the opposite of freedom.”