Haris Ashley
The Affordable Care Act (ACA) has faced multiple challenges in the Supreme Court, with the most recent case heard in April 2025. This case revolves around the constitutionality of a government task force determining what preventive healthcare services insurers must cover at no cost. While the Supreme Court's liberal members seemed inclined to uphold the task force's authority, the conservative justices appeared divided. If the Supreme Court rules in favor of the plaintiff, private insurers may no longer be required to provide certain cost-free preventive services, impacting over 150 million Americans. However, the general consensus is that the ACA remains intact and is here to stay.
| Characteristics | Values |
|---|---|
| Date of ruling | June 2021 |
| What does ACA stand for? | Affordable Care Act |
| Other names for ACA | Obamacare |
| What is ACA? | A law that provides a vast array of additional consumer protections that extend to most Americans in one way or another |
| What does ACA do? | Requires insurers to cover certain preventive health services at no cost |
| Who does ACA cover? | More than 150 million Americans |
| What does ACA cover? | Early screenings and interventions for chronic conditions, cancer screenings, cholesterol-lowering medications, drugs to prevent the spread of HIV, breast cancer screenings, lung cancer screenings, HIV-prevention drugs, medication to lower the chance of breast cancer for high-risk women, etc. |
| Who is challenging ACA? | A group of Christian-owned businesses, Braidwood Management, Texas-based employer, and Jonathan Mitchell, a conservative attorney |
| What is the challenge based on? | The challenge is based on the Constitution's Appointments Clause. It states that the task force is not legally structured and possesses unchecked power to influence the healthcare system as its members are not nominated by the president and confirmed by the Senate. |
| What is the current status of ACA? | The Supreme Court dismissed the case, and ACA remains intact. |
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What You'll Learn
ACA's future is secure despite Supreme Court challenges
The Affordable Care Act (ACA) has faced several challenges in the Supreme Court, yet it remains intact. The ACA's future appears secure, despite ongoing legal challenges.
In April 2025, the Supreme Court heard arguments in a case brought by a Texas-based employer, Braidwood Management, and supported by Christian-owned businesses and right-leaning groups. The plaintiffs argued that the ACA's requirement for private insurers to cover certain preventive services, such as cancer screenings and HIV-prevention drugs, at no cost was unconstitutional. They claimed that the US Preventive Services Task Force, which decides on the covered services, was not legally structured and possessed unchecked power as its members were not nominated by the president or confirmed by the Senate. This case did not seek to overturn the ACA itself, and legal analysts believed it was unlikely the Supreme Court would take up a case that did.
Justices Brett Kavanaugh and Amy Coney Barrett appeared skeptical of the plaintiffs' arguments, suggesting that the task force was not as independent or powerful as critics claimed. The Court's three liberal members—Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson—were inclined to uphold the task force's authority. Previous rulings by the Supreme Court had shown a willingness to curtail the powers of independent agencies and task forces, but in this case, the Court seemed likely to uphold the ACA's preventive care coverage mandate.
This was the third time the ACA had survived challenges in the Supreme Court. In 2012 and 2015, the Court ruled in favor of the ACA, and in 2021, the Court dismissed a case challenging the individual mandate, indicating an increasing favoritism towards the ACA among the justices. While the ACA will likely continue to face legal challenges, the general consensus is that it is here to stay.
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ACA's individual mandate and penalty
The Affordable Care Act (ACA) includes an individual mandate, also known as the shared responsibility provision. This provision requires individuals to purchase minimum essential coverage or face a tax penalty unless they are eligible for an exemption. The individual mandate was phased in over a three-year period from 2014 to 2016. During this time, those who lacked qualifying coverage were subject to a "shared-responsibility payment", or a penalty.
The individual mandate was one of the least popular provisions of the ACA. In 2012, the U.S. Supreme Court ruled that the mandate was constitutional. However, in December 2017, Congress passed the Tax Cuts and Jobs Act, which eliminated the individual mandate penalty effective January 1, 2019. As a result, there is currently no federal penalty for not having health insurance, although some states have enacted their own penalties.
The elimination of the penalty had varying effects. While it was predicted to reduce health insurance enrollment, it also made ACA-compliant coverage more affordable through subsidies. Additionally, it allowed people to choose whether or not to purchase health insurance without facing a tax penalty.
The ACA has faced several legal challenges related to the individual mandate and penalty. In 2020, a case known as California v. Texas (or Texas v. Azar) was brought before the Supreme Court, challenging the constitutionality of the mandate without the penalty. In 2021, the Supreme Court upheld the ACA, dismissing the case. This marked the third time the ACA had survived challenges in the Supreme Court.
Most recently, in April 2025, the Supreme Court heard a case regarding the ACA's preventive care coverage mandate. The Court appeared divided over the constitutionality of a government task force that determines what preventive health care services insurers must cover at no cost. A ruling is expected by the end of June, and it could potentially impact the preventive care coverage requirements for approximately 150 million Americans.
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ACA's requirement to maintain health insurance
The Affordable Care Act (ACA), also known as Obamacare, is a federal law that requires most Americans to maintain health insurance. While the ACA has faced several challenges in the Supreme Court, it has survived each of these challenges and remains intact. The ACA continues to provide a vast array of consumer protections that extend to most Americans.
One of the key provisions of the ACA is its requirement that nearly all health plans cover a wide range of preventive care benefits at no cost to the patient. This includes immunizations, obesity screening and counseling, and medications to prevent the spread of HIV, lower cholesterol, and reduce the risk of breast cancer for high-risk women. More than 150 million Americans rely on these preventive services, and public health groups argue that eliminating them would negatively impact the long-term health of Americans and disease prevention efforts.
The ACA also mandates that employers with 50 or more full-time employees offer affordable health insurance that provides minimum value to 95% of their full-time employees and their children up to the age of 26. Employers who fail to comply with this mandate may be subject to penalties. Small employers, generally those with fewer than 50 full-time employees, may be eligible for credits and other benefits.
While the ACA has faced legal challenges, it appears unlikely that the Supreme Court would take up a case aiming to overturn the entire law. The most recent case, heard in April 2025, focused on the constitutionality of a government task force that determines what preventive health care services must be covered by insurers at no cost. The Supreme Court appeared divided, but it seems likely that the ACA's preventive care coverage mandate will be upheld.
Overall, the ACA's requirement to maintain health insurance remains in place, and the law continues to provide important protections and benefits for individuals and employers.
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ACA's expanded eligibility for Medicaid
The Affordable Care Act (ACA) has faced multiple challenges in the Supreme Court, but it remains intact. The ACA expanded Medicaid eligibility to all adults under the age of 65, including parents and adults without dependent children. This expansion was made optional for states by a 2012 Supreme Court ruling, and as of March 2023, 40 states and the District of Columbia have chosen to adopt it.
The ACA allows states to expand Medicaid coverage to adults with incomes up to 138% of the poverty level, or about $20,780 annually for an individual or $35,630 for a family of three. This has dramatically lowered uninsured rates in states that have adopted the expansion. In these states, the uninsured rate among low-income, non-elderly adults fell by more than half between 2013 and 2022, from 35% to 15%.
The ACA also required the federal government to pay 100% of state Medicaid costs for certain newly eligible individuals through 2016. At that point, the matching rate began phasing down to 90% in 2020 and thereafter. This has resulted in net savings for many states, as the federal government pays the vast majority of the cost of expansion coverage.
The expansion of Medicaid under the ACA has had positive economic impacts on multiple types of healthcare providers. It has enabled states to spend less on programs for people with mental health or substance use disorders, as federal Medicaid matching funds are now available to help pay for their treatment. It has also enabled states to lower their corrections spending as more incarcerated people became eligible for and enrolled in Medicaid.
The ACA's expanded eligibility for Medicaid has provided coverage for more than 10% of all Americans, and it continues to face legal challenges. However, it appears unlikely that the Supreme Court would take up any case that aims to overturn the ACA itself.
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ACA's preventive services and screenings
The Affordable Care Act (ACA), also known as Obamacare, has faced multiple challenges in the Supreme Court. However, the ACA has survived these challenges, including the most recent case in 2025, which the Supreme Court dismissed without taking any action. This means that the ACA remains intact, and there is a general consensus that it is here to stay.
One of the critical aspects of the ACA is its preventive services and screenings mandate. This mandate requires health plans to cover a range of preventive services and screenings at no cost to the patient. These services are free when provided by a doctor or other provider in the patient's plan network. The ACA's preventive services and screenings mandate has been a game-changer for millions of Americans, providing access to evidence-based preventive care and early detection of serious medical conditions.
The specific preventive services and screenings covered by the ACA have evolved over time and are gradually incorporated into health coverage as they are updated. For example, in 2021, the recommended age to begin screening colonoscopies was lowered from 50 to 45, and health plans had until 2023 to implement this change. Other covered services include lung cancer screening for high-risk adults, colorectal cancer screenings, PrEP for HIV prevention, mental health screenings, obesity screening and counseling, and various medications such as statins to prevent heart disease, cholesterol-lowering drugs, and HIV-prevention drugs.
The ACA's preventive services and screenings mandate has faced legal challenges, with some arguing that the process for deciding which services must be covered is unconstitutional. However, the Supreme Court appeared divided over these challenges, and it seems unlikely that the mandate will be overturned. A ruling on this issue is expected by the end of June 2025, and it will have significant ramifications for the estimated 150 million Americans who rely on these preventive services.
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Frequently asked questions
No, the ACA is not going away. This is the third time the ACA has survived challenges in the Supreme Court.
The ACA, or Affordable Care Act, is also known as Obamacare.
The ACA provides a vast array of additional consumer protections that extend to most Americans. For example, it requires insurers to cover certain preventive health services at no cost.
The Supreme Court case concerns the constitutionality of a government task force that determines what preventive health care services insurers must cover at no cost under the ACA.
