Perhaps no recent major legislation has been shadowed as dramatically by legal battles as the Affordable Care Act that President Obama signed into law eight years ago.
Twice since 2010, the sweeping law, often called Obamacare, has ended up before the U.S. Supreme Court. In both cases, Chief Justice John G. Roberts Jr. joined the court’s four more liberal justices to preserve the law.
If Brett M. Kavanaugh, President Trump’s choice to replace retiring Justice Anthony M. Kennedy, is confirmed this fall, he may not tip the balance on the court when it comes to the law’s fate. But he almost certainly will have to weigh in on new cases with potentially far-reaching impact on Americans’ healthcare.
Here are some of the potentially consequential healthcare cases currently making their way through the federal courts.
Because the Supreme Court agrees to hear only a small number of cases every year, the court may not rule on all of these cases. But the justices will probably at least be asked to decide whether they deserve consideration.
Case: Texas vs. Azar
What’s at issue: A group of 20 Republican governors and attorneys general is seeking to invalidate the entire healthcare law. They argue that the law no longer can work because Congress last year eliminated a a penalty on people who do not have health coverage.
Why it’s important: If successful, the lawsuit could have a huge impact, effectively stripping health coverage from tens of millions of Americans. The Trump administration has backed portion of the argument being made by the GOP attorneys general, calling for the elimination of provisions of the law prohibiting insurers from turning away sick consumers.
Status: The case is scheduled for a hearing Sept. 5 in federal district court in Texas.
Prospects: The federal courts in Texas are among the most conservative in the country, making it very possible the case could advance. If the case makes it to the Supreme Court, it would potentially set up a third do-or-die moment for the healthcare law.
Case: Stewart vs. Azar
What’s at issue: A group of low-income residents of Kentucky challenged the Trump administration’s move to allow Kentucky to impose work requirements on enrollees in the state Medicaid insurance program.
Why it’s important: The federal government has not historically allowed states to make work a condition for receiving Medicaid coverage, but starting with Kentucky, the Trump administration has approved a series of state requests to impose work requirements. These mandates, if allowed to stand, are expected to reduce health coverage and fundamentally change Medicaid.
Status: A federal judge in Washington, D.C., in June strongly backed the challenge to work requirements. The Department of Health and Human Services is now reconsidering Kentucky’s request to impose the requirements.
Prospects: The Trump administration is widely expected to once again approve the request. That would spark another legal challenge, which could well get to the Supreme Court someday.
Case: New York vs. Acosta
What’s at issue: A group of 12 Democratic attorneys general are challenging a Trump administration regulation issued this year that makes it easier for individuals and small employers to band together to buy so-called association health plans that do not meet standards set by the Affordable Care Act. They argue the administration is violating the healthcare law’s aim of establishing minimum insurance protections.
Why it’s important: The Trump administration’s moves to loosen regulations on health plans have become a major flash point and test of the healthcare law. If allowed to move forward, proponents argue these moves will make health plans cheaper. But independent analyses have concluded that looser rules will mean more costly plans for sick Americans.
Status: The case was filed in July in federal district court in Washington, D.C., and is awaiting a hearing there.
Prospects: The challenge seems unlikely to get a positive reception from the conservative majority on the Supreme Court, if it ever gets that far. But future lawsuits are expected to challenge other administration moves to relax regulation — such as allowing more short-term health plans that also don’t have to meet current insurance standards.
Case: West Alabama Women’s Center vs. Miller
What’s at issue: The state of Alabama in 2016 passed a law barring a surgical technique known as dilation and evacuation, or D&E, which is commonly used to end a pregnancy in the second trimester. The ban was challenged in court by two abortion providers in the state.
Why it’s important: Alabama is among several conservative states that in recent years have passed new laws seeking to restrict access to abortion services. Other tactics have included limits on Planned Parenthood funding and additional licensing requirements for abortion providers. Some believe this case could give the Supreme Court the opportunity to revisit the broader issue of abortion rights set out by the court in its landmark 1973 Roe vs. Wade decision.
Status: A federal appeals court in Atlanta in August unanimously upheld an injunction barring the state from the implementing the new restrictions.
Prospects: Many legal experts believe it is very likely the Supreme Court will take at least one case soon about state restrictions on abortion services.
Case: Columbus vs. Trump
What’s at issue: The city of Columbus, Ohio, and a group of other cities and individuals is suing the president, alleging that he is deliberately undermining the Affordable Care Act, thereby ignoring his constitutional responsibility to enforce the law and subjecting individual Americans to higher healthcare costs.
Why it’s important: This sweeping lawsuit, if successful, would represent a historic rebuke of a president for failing to follow the law and could force the administration to reverse a number of steps it has taken over the last two years to weaken the Affordable Care Act.
Status: The case was filed in August in federal district court in Maryland and is awaiting a hearing there.
Prospects: The case appears to be a longshot, but its arguments summarize the widespread feeling among many working in the healthcare system that the Trump administration has systematically worked to weaken the 2010 healthcare law.