Today, November 10, 2020, the Supreme Court is hearing oral arguments in California v. Texas, a case that challenges the Affordable Care Act (ACA). It is very important to note that the ruling on this case will not be immediate, rather, the Supreme Court is expected to rule on California v. Texas by June 2021.

The main question in California v. Texas is whether the ACA should be struck down. A June 25th brief filed by the Trump Administration in Texas v. United States argues the entire ACA is invalid because in December 2017 Congress eliminated the ACA’s tax penalty for people who do not purchase health insurance.

The administration’s brief was filed in support of a group of Republican-led states seeking to undo the ACA. Meanwhile, California Attorney General Xavier Becerra is leading a coalition of more Democratic states to defend the ACA before the Supreme Court.

With respect to California v. Texas, the Supreme Court has three main options for a ruling:

1. The court may rule to allow the ACA to stand as is, with no change.
2. The court may rule the ACA in its entirety is unconstitutional.
3. The court may rule that parts of the ACA are unconstitutional.

In order for the Supreme Court to issue a ruling there are four main components that are going to impact their decision:

• Severability – This is the concept that the individual mandate is unconstitutional without a financial penalty. Two lower courts made this ruling previously. If the Supreme Court focuses on severability, this may signal that they are inclined to rule the ACA is unconstitutional.
• Congressional intent – This is the concept that the Supreme Court will look at the intent of Congress is 2010 and in 2017 to gain a better understanding if Congress meant for the ACA to stand without the individual mandate.
• Scalpel rather than knife – This is the concept that the Supreme Court could rule the ACA is invalid, but in a way that would allow the federal government to keep enforcing parts of the ACA that would not negatively impact States.
• Standing – the Supreme Court may look to the lower court cases and arguments to decide the fate of the ACA. According to the lower court’s ruling, the two individuals and the states challenging the ACA have standing to sue. Now it will be up to the Supreme Court to determine if the individuals and states will be negatively impacted because there is no financial penalty for not purchasing health insurance since Congress zeroed out the individual mandate.

While the country awaits the decision of the Supreme Court in June 2021, it is important to realize that there are millions of people without access to health care. According to Kaiser Family Foundation Brief “Key Facts about the Uninsured Population” there are 28.9 million people who are uninsured in the country.

Our job is far from over. Prior to COVID-19, Free and Charitable Clinics and Pharmacies provided health care to 2 million uninsured patients annually. This year, as a result of COVID-19, 74% of our clinics are reporting an increase in patient demand due to the economic impact of the pandemic according to an NAFC Report.

America’s Free and Charitable Clinics and Pharmacies will continue to provide access to health care to those in need.  We will continue to serve on the frontlines of the pandemic and stand in the health care gap in this country.