On Nov. 10, 2020, the U.S. Supreme Court heard the first case challenging a key component of the Affordable Care Act since the confirmation of the court's newest justice, Amy Coney Barrett.

California v. Texas centers on the constitutionality of the ACA's individual mandate and how it underpins the law, which has remained remarkably resilient despite continued challenges. However, regardless of what the Supreme Court decides, UW Law Professor Sallie Sanford says health care access and affordability will remain dominant issues for the foreseeable future.

In three minutes, Sanford discusses the landmark case's main issues, impacts of its outcome, and the history and current state of the ACA. She also shares resources for those who do not have health insurance through their employer to find available options: Washingtonians can go to wahealthplanfinder.org, and individuals in other states can visit healthcare.gov.

Read the Transcript

Sallie Sanford: My name is Sallie Sanford and I'm an associate professor at the University of Washington School of Law with an adjunct appointment at the School of Public Health.

Three-Minute Legal Tips: Can you briefly explain California v. Texas?

SS: California v. Texas was heard before the Supreme Court on November 10, 2020 and in this case the challengers argue that the individual mandate to the Affordable Care Act is now unconstitutional and therefore the entire wide-ranging law must be thrown out. In 2012, the Supreme Court ruled that the Affordable Care Act's individual mandate is within Congress's power to impose taxes, but then in late 2017 Congress zeroed out the tax penalty. Shortly thereafter, a group of states filed suit arguing that the law now lacks a constitutional underpinning

TMLT: What are the key issues?

SS: Now for issues there are three key issues before the Supreme Court. The first is standing. Do the parties have standing to challenge the law? The second is the constitutionality of the mandate. And the third if they decide that the mandate is unconstitutional, whether it is severable from the remainder of the law.

TMLT: If the Supreme Court rules that the individual mandate is now unconstitutional, does that mean that the entire ACA must be thrown out?

SS: No. So, if the Supreme Court rules that the individual mandate is no longer constitutional, then it will get to the severability analysis. First, the Supreme Court could decide that the individual mandate is fully separable from the rest of the law. You just take a big black pen and cross it out. Alternatively, the Supreme Court could decide that it is bound up with other parts of the law of the statute, such as the pre-existing condition protections and other insurance regulations. And then the question would be which pages of the law are thrown out. Finally, of course, the Supreme Court could decide that the entire law must be thrown out. This is probably the least likely outcome, but it's certainly possible.

TMLT: How will this affect average Americans?

SS: You know, it's hard to overstate how disruptive and destructive it would be if the Supreme Court threw out the entire Affordable Care Act. So, by most estimates about 20 million people would lose their health insurance in short order and this relates to two central and also expensive parts of the Affordable Care Act. The first is its expansion of Medicaid to cover Americans who don't have employer-provided coverage and who make at or around the poverty level. And then secondly, the Affordable Care Act regulated and subsidized the individual health insurance market for people above that level of income and many of them, if not most, would find it difficult to pay their premiums without the subsidies

TMLT: Is the Affordable Care Act still the law?

SS: Right now, the Affordable Care Act remains the law. It's been a remarkably resilient law and we are now in November of 2020 in the midst of open enrollment so those who don't have health coverage through their employer can go to a website and see what their options are. In Washington state, it's healthplanfinder.org and then for the rest of the country you can go to healthcare.gov and be directed to the appropriate website. It's also important to know that regardless what the Supreme Court decides, healthcare access and affordability are likely to be dominant issues for the foreseeable future.