On Nov. 10, 2020, the U.S. Supreme Court heard oral arguments in a challenge to the Affordable Care Act (ACA) from Republican states, led by Texas and supported by the Trump Administration, in Texas vs. California. A group of Democratic states led by California and the U.S. House of Representatives are defending the law in the case. The future of the ACA and the millions of Americans insured under it is at stake. The court will decide whether the law is constitutional after Congress reduced the individual insurance mandate penalty to $0 and, as a consequence, if all other parts of the law, including the protections for individuals with pre-existing conditions and the health marketplaces, can be “severed” from the insurance mandate and upheld. An additional question is whether the challengers have produced adequate evidence to sue on the basis that people have been harmed by Congress’ action to virtually eliminate the insurance mandate penalty.

At least two conservative members would need to join the court’s three liberal justices on a decision to preserve the law. In two previous challenges, Chief Justice Roberts ruled in favor of the ACA. During the hearing, conservative justices including Roberts and Kavanaugh appeared openly skeptical of the challenger’s argument that the ACA cannot stand without the insurance mandate penalty.  Justice Kavanaugh stated, “It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the act in place.” In addition, Chief Justice Roberts and Justice Gorsuch also questioned whether the challengers have sufficient legal standing to sue against the ACA. Many legal experts have reported that the justices’ line of questioning indicates that a majority of the court is leaning towards upholding the law. The Supreme Court’s decision in the ACA case in expected in the Spring of 2021. The ATS joined an amicus brief to the court in support of the ACA.