The U.S. Supreme Court rejected the third major challenge to the national health care law known as "Obamacare" on Thursday.
The justices, by a 7-2 vote, left the entire Affordable Care Act intact in ruling that Texas, other Republican-led states, and two individuals had no right to bring their lawsuit in federal court.
The Biden administration says 31 million people have health insurance because of the law. Its major provisions include protections for people with existing health conditions, a range of no-cost preventive services, expansion of the Medicaid program that ensures lower-income people, and health insurance markets offering subsidized plans.
"The Affordable Care Act remains the law of the land," President Biden said, saluting the ruling and calling for building on the healthcare law that was enacted when he was vice president.
Also left in place is the law's now-toothless requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero.
Justice Stephen Breyer wrote for the court that the states and people who filed a federal lawsuit "have failed to show that they have standing to attack as unconstitutional the Act's minimum essential coverage provision."
In dissent, Justice Samuel Alito wrote, "Today's decision is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue." Alito was a dissenter in the two earlier cases in 2012 and 2015, as well.
Like Alito, Justice Clarence Thomas was in dissent in the two earlier cases, but he joined Thursday's majority, writing, "Although this Court has erred twice before in cases involving the Affordable Care Act, it does not err today."
Because it dismissed the case for the plaintiff's lack of legal standing — the ability to sue — the court didn't actually rule on whether the individual mandate is unconstitutional now that there is no penalty for forgoing insurance. Lower courts had struck down the mandate, in rulings that were wiped away by the Supreme Court decision.
The health law is now undergoing an expansion under Biden, who sees it as the foundation for moving the U.S. to coverage for all. His giant COVID-19 relief bill significantly increased subsidies for private health plans offered through the ACA's insurance markets, while also dangling higher federal payments before the dozen states that have declined the law's Medicaid expansion. About 1 million people have signed up with HealthCare.gov since Biden reopened enrollment amid high levels of COVID cases earlier this year.