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Association Urges Supreme Court to Uphold ACA

America’s Essential Hospitals, in coalition with other national hospital associations, filed an amicus brief urging the Supreme Court to expeditiously review a decision of the U.S. Court Appeals for the Fifth Circuit on the constitutionality of the Affordable Care Act’s (ACA’s) individual mandate and the fate of the law.

How We Got Here

In 2017, Congress reduced the tax penalty associated with the individual mandate to zero but did not eliminate the mandate altogether. Soon after, a group of Republican-led states filed suit to challenge the constitutionality of the individual mandate, arguing that, absent a penalty, it no longer falls under Congress’ taxing power. In 2018, the U.S. District Court for the Northern District of Texas agreed with this argument and deemed the individual mandate unconstitutional. The judge also agreed with the states that the individual mandate is inseverable from the rest of the ACA, rendering the entire law unconstitutional.

The case was appealed to the U.S. Court of Appeals for the Fifth Circuit, with Democratic-led states and the U.S. House of Representatives defending the ACA and arguing that the individual mandate is lawful and severable from the rest of the ACA. In a decision on Dec. 18, 2019, the Court of Appeals agreed with the District Court that the individual mandate is unlawful but declined to rule on whether the mandate is severable from the rest of the ACA, leaving the fate of the law unclear. The Court of Appeals sent the case back to the District Court to conduct a more thorough review of which parts of the ACA could survive without the mandate. In response to the Court of Appeals’ decision, the Democratic-led states filed a petition with the Supreme Court, asking it to review the case and dismiss the Court of Appeals’ ruling.

Hospital Association Arguments

America’s Essential Hospitals — together with the American Hospital Association, the Federation of American Hospitals, the Catholic Health Association of the United States, and the Association of American Medical Colleges — filed an amicus brief urging the Supreme Court to review the decision of the Court of Appeals. The brief asserts that the mandate is severable, arguing that the ACA is more than the individual mandate and, more broadly, its coverage provisions. Therefore, the associations argue, the law can continue to function apart from the individual mandate, if the mandate is struck down. The brief also describes the devastating impact striking down the law would have on patients, the hospitals that serve them — particularly safety-net and rural hospitals — and the health care system, overall. The associations argue that prolonging review of the case through the lower courts will lead to protracted uncertainty for hospitals and health systems.

Next Steps

The Democratic-led states and the House of Representatives asked that the Supreme Court take up the case and expedite its review to April, with a decision this summer. However, the Supreme Court on Jan. 21 denied the request for an expedited schedule.

The court’s refusal to expedite the case means it will not consider the issue during the current term, which ends in June. The court still could agree to consider the case in the fall.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Shahid Zaman is a senior policy analyst at America's Essential Hospitals.

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