ACA under siege: Legal challenges and repeal attempts

Barack Obama gives ACA speech
President Barack Obama addresses a crowd in Miami last month to make his case for Republicans and Democrats to work together to fix the Affordable Care Act's flaws. But with the results of Tuesday's elections, a repeal of the healthcare reform law looks more likely.

From the moment it was signed into law, the Affordable Care Act has been faced with a near-constant stream of opposition from Republican lawmakers calling for a repeal along with a slew of legal cases challenging various aspects of the landmark legislation.

Following Donald Trump’s presidential victory--as well as a GOP majority in the House and Senate--the future of the ACA is more tenuous than ever before. Below is a chronological list of the ongoing challenges that faced the law during the last six years.

March 2010: Just two days after President Barack Obama officially signed the ACA into law, Rep. Steve King (R-Iowa) sponsored a bill calling for a full repeal. At the same time, Attorneys General from 14 states filed lawsuits to block the law. Months later, the Congressional Budget Office said repealing major components of the ACA would cost $455 billion over 10 years.

Sen. Harry Reid (D-Nev.)

January 2011: Less than a year later, the GOP-led House of Representatives votes to repeal the ACA 245-189 in a move that is mostly symbolic since Senate Majority Leader Harry Reid (D-Nev.) said he won't allow the bill to reach the Senate floor.

November 2011: The Supreme Court agrees to hear a legal challenge of the ACA brought by 26 states regarding the legality of an individual mandate for Americans to purchase health insurance, following a decision by United States Court of Appeals for the 11th Circuit.

June 2012: Month’s later, the Supreme Court upholds the individual mandate with a 5-4 decision, arguing the tax penalty for failing to purchase insurance is constitutional.

May 2013: Three years after the ACA is signed into law, Republican legislators continue to make repealing it a primary platform, accumulating as many as 37 attempts to repeal the law.

November 2013: The Supreme Court agrees to hear two cases involving the ACA’s contraceptive mandate, including the one brought by Hobby Lobby, a retail chain founded by Evangelical Christians.

June 2014: In a 5-4 decision, the Supreme Court rules in favor of Hobby Lobby, deciding that closely held corporations cannot be required to provide contraceptive coverage. But the ruling offered several qualifications, including a pathway for the government to pay for contraception for women.  Months later, the Obama administration outlines amended requirements that require insurers to cover the cost of contraception for employers with religious objections.

November 2014:

  • The Supreme Court agrees to hear King v. Burwell, a case derived from two federal lawsuits challenging the legality of ACA subsidies. Senate Majority Leader Mitch McConnell (R-Kt,) says the case offers the best opportunity to tear down the law.
  • House Speaker John Boehner (R-Ohio) and the House of Representatives files a lawsuit against the Obama administration (House v. Burwell) claiming that it violated the Constitution by postponing the employer mandate and illegally transferring $175 billion to insurance companies to pay for cost-sharing subsidies.

June 2015: The Supreme Court rules 6-3 to uphold health insurance subsidies under the ACA in King v. Burwell. The Court rules that tax credits under the law are permitted for “insurance purchased on any exchange created under the act.”

September 2015:

  • A federal judge rules that the House has the right to sue the Obama administration over money spent on the healthcare law, allowing lawmakers to pursue claims filed the previous year in House v. Burwell.
  • Republican presidential candidate Donald Trump unveils plans to repeal and replace the ACA if he is elected to office, indicating he will “make a deal with existing hospitals to take care of people.”

November 2015: The Supreme Court agrees to hear Zubik v. Burwell, another challenge to the ACA’s contraceptive mandate, this time from a group of religious organizations that argue the law’s requirement that organizations petition the government in order to opt

Supreme Court
The Supreme Court has heard several challenges to the Affordable Care Act,
including King v. Burwell and Burwell v. Hobby Lobby.

out of the mandate places an unjust burden on religious freedom and violates the Religious Freedom Restoration Act. Two months earlier, a court of appeals ruled that revamped contraceptive requirements from the Obama administration unjustly forces religious employers to pay for the costs.

January 2016: Obama vetoes a bill passed through the House and Senate that repeals large portions of the ACA, including the individual mandate, the employer mandate and Medicaid expansion. A month later, the House fails to come up with the two-thirds majority necessary to override the veto.

February 2016: Oregon’s failing CO-OP sues the federal government for $5 billion for failing to make risk corridor payments under a provision of the ACA. Over the next seven months, several other insurers will file their own lawsuits, including Highmark and Blue Cross Blue Shield of North Carolina.

March 2016:

  • Republican presidential candidate Donald Trump offers a fleshed-out plan to repeal and replace the ACA that includes allowing payers to sell insurance over state lines and allowing states to run their own Medicare programs.
  • Reports indicate that a ruling in the House v. Burwell lawsuit could destabilize the ACA marketplaces.

May 2016:

  • The Supreme Court takes the unusual step of declining to rule in Zubik v. Burwell, remanding the case to lower courts to find a compromise to the contraceptive mandate for religiously affiliated employers. During opening arguments, the Court sought to find an alternative that both sides could agree on, but subsequent briefs submitted by both parties offered no signs of consensus.
  • A district judge rules in favor of House Republicans in House v. Burwell, saying that the law violates the Constitution by paying out reimbursements for ACA subsidies without approval from Congress.
  • Two GOP representatives unveil the “World’s Greatest Healthcare Plan” that eliminates the ACA’s individual mandate and makes every American citizen eligible for tax benefits deposited into a Roth Health Savings Account. Meanwhile, House Republicans say they are close to a more comprehensive plan to replace the ACA.

June 2016:

  • House Speaker Paul Ryan
    House Republicans led by Speaker Paul Ryan unveil a long-awaited plan to replace the ACA. Entitled “A Better Way,” the plan calls for a full repeal of the ACA, replacing it with revamped exchanges, high-risk insurance pools and Medicaid reforms, while preserving certain provisions of the original law that allow people with pre-existing conditions to purchase insurance.  
  • A report indicates that 24 million additional Americans would be uninsured if the ACA is repealed after the 2016 election. A subsequent report indicates that the GOP’s repeal and replace approach is fraught with political concerns.

October 2016: The Obama administration files a brief as part of an appeal to the House v. Burwell ruling, criticizing GOP lawmakers and arguing that the House’s lawsuit is unconstitutional.

November 2016: Donald Trump wins the presidential election, casting significant doubt over the future of the ACA. Trump repeatedly vowed to repeal the ACA, and the presidential victory provides the GOP the opportunity to implement their own healthcare reform.