Primary issues: The Affordable Care Act (ACA); Equitable access to affordable health insurance; coverage for people with pre-existing conditions (including domestic violence); discrimination against women that undermines their health and economic security.
Oral Arguments: November 10 at 10AM. Due to the pandemic, you can listen to oral arguments here.
WLP’s Role in the Case: WLP joined an amicus curiae (“friend of the court”) brief filed by National Women’s Law Center on behalf of 80 additional organizations that work toward ensuring women and their families have access to affordable and comprehensive health insurance and healthcare.
Texas v. California Case Overview
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and sometimes referred to as Obamacare, is a federal statute enacted by Congress and signed into law in 2010.
The Affordable Care Act and consumer protections embedded within the law—including protections for people with pre-existing conditions, coverage of Essential Health Benefits such as maternity and mental health care, and protection against women charged more than men for the same plans—are once again on the line at the U.S. Supreme Court.
Led by Texas, 2 individuals and 18 states led by Republicans (known as “state plaintiffs”) originally sued the federal government in an attempt to overturn the ACA. (Wisconsin and Maine withdrew from the case after electing Democrats during mid-term elections in 2018.) When the Trump administration refused to defend the ACA and joined the states in opposition, 21 state attorneys general, led by California, and House Democrats intervened to defend the law. That is why the case is now known as Texas v. California.
In short, the plaintiffs in Texas v. California challenge the constitutionality of the ACA’s individual mandate and also its severability—which means that this litigation challenges the constitutionality of the law itself. The individual mandate provides that most people must maintain a minimum level of health insurance coverage; those who do not do so must pay a financial penalty (known as the shared responsibility payment) to the IRS. The mandate is being challenged because and despite Congress re-setting the financial penalty to zero dollars in 2017 (see case history below for detail).
Pennsylvania joined a bipartisan group of governors that filed a brief arguing the ACA should be upheld and consequences for overturning it would be devastating for residents.
The ACA and Women’s Health
The ACA was the first federal law to broadly prohibit sex discrimination in health care. The brief we joined focuses on the link between the Affordable Care Act and women’s health.
From the brief, which you can read here:
Before the ACA, insurers in the individual market excluded coverage, or required substantial out-of-pocket payments, for essential women’s health services such as maternity care and mammograms, while charging women higher premiums based solely on their sex. Insurers also denied coverage to many women based on common medical conditions and procedures, such as pregnancy or prior cesarean delivery.
Congress enacted specific provisions of the ACA to tackle those problems. For example, through the guaranteed-issue and community-rating provisions, the ACA ended what has widely been referred to as “gender rating” (charging women more for premiums based on their sex) and ended denials and rate increases for pre-existing conditions.
The ACA’s anti-discrimination consumer protections have significantly improved the health and economic independence of women, including women of color. Among other advances, more women and children are insured, women’s use of preventive services has increased, and maternal and infant mortality rates, which are at crisis levels for Black and Native women and children, have begun to decline in Medicaid-expansion states.
In Pennsylvania, 1 in 10 adults have health insurance due to the ACA, an estimate made before the COVID-19 pandemic, which has disproportionately pushed women out of the workforce.
Case History
Texas v. California has an unusual case history. The individual mandate was previously challenged and upheld as a constitutional exercise of Congress’ taxing power by a five-member majority of the Supreme Court in NFIB v. Sebelius in 2012.
Then, in 2017, the Trump Administration set the shared responsibility payment to zero dollars via the Tax Cuts and Jobs Act, which designated that the zero-dollar penalty would begin in 2019.
This tactic enabled state attorneys general, led by Texas, to challenge the constitutionality of the mandate. Since the Trump Administration eliminated the financial penalty for not having insurance, they argued it was no longer technically a tax since a tax produces revenue for the federal government.
This technical distinction is important because, in 2012, the U.S. Supreme Court upheld the mandate based on Congress’ constitutional authority to set taxes. Further, Texas also argued that the mandate was inseverable from the law, and so invalidating the mandate overturns the entirety of the ACA.
In December 2019, the 5th Circuit affirmed the trial court’s decision the individual mandate was now no longer constitutional, which led to the case being taken up by the U.S. Supreme Court.
Oral arguments begin at 10AM on November 10. Due to the pandemic, a livestream is available here.
A decision is expected in spring, 2021.
The Women’s Law Project is a public interest law center in Pennsylvania devoted to advancing and defending the rights of women, girls, and LGBTQ+ people in Pennsylvania and beyond.
November 2020: Our physical offices are still closed due to the pandemic but we are OPEN and working to serve your needs. Contact us here. Sign up for WLP’s Action Alerts. Stay up to date by following us on twitter, Facebook, and Instagram.
THE MASKED BALL: Our annual Philadelphia gala is on November 20! Please join us for this virtual celebration to support gender justice in Pennsylvania. Information & registration here.
