As the nation winds down from the presidential election, a similarly impactful decision is ramping up: the fate of the Affordable Care Act (ACA) in the hands of the U.S. Supreme Court. California v. Texas is the latest of many legal challenges to the ACA. This case relates to a decision made by Congress in 2017 to decrease the penalty for not maintaining insurance to $0. Because the penalty was rendered essentially fruitless, the question arose as to whether the individual mandate is constitutional. Further, if it is determined to be unconstitutional, the court must determine the "severability" of the mandate from the rest of the ACA. The Kaiser Family Foundation explains more in their brief from September 2020.
In addition to providing access to coverage for many nationwide, the ACA constructed funding streams to states and provided protections for consumers. Massachusetts is unique to other states in that we had universal health coverage prior to the implementation of the ACA which significantly reduced rates of uninsurance. Should the ACA be overturned, the most immediate impacts on Massachusetts would be the dearth of federal funding and sudden increase in the uninsured population. The extent of these changes depends on whether the state can revert to pre-ACA funding levels from the federal government.
Our colleagues at the Blue Cross Blue Shield of Massachusetts Foundation detailed these scenarios in their recent brief, and estimates a potential loss of over $3 billion in funding from the federal government, and between 69,000-422,000 residents losing coverage – in the midst of a pandemic.
Hearings on the case began this past week, but a decision from the U.S. Supreme Court is not expected until next year.