Title: Legal Cases and State Legislative Actions Related to the ACA
Headings: Legal Cases and State Legislative Actions Related to the ACA
Legal Cases and State Legislative Actions Related to the ACA
Supreme Court Cases Challenging the ACA
California v. Texas
King v. Burwell
National Federation of Independent Business v. Sebelius
Contraception Cases
State Legislative Actions Safeguarding the ACA
Consumer Protections
State-Level Individual Mandate Requirements
State Legislative Actions Challenging the ACA
Additional Resources
NCSL Resources
Other Resources

Content: In 2015, the Supreme Court ruled that consumers purchasing health insurance through HealthCare.gov are eligible for health insurance subsidies, and that ruling otherwise would destabilize the health insurance marketplaces—the opposite intent of the federal health law. National Federation of Independent Business v. Sebelius
In 2012, 26 states, several individuals and the National Federation of Independent Business challenged the constitutionality of the individual mandate and provisions in the ACA requiring states to expand Medicaid coverage or risk losing all federal Medicaid funding. The Supreme Court ruled that the individual mandate was constitutional under Congress’ taxing power. However, the Supreme Court ruled that Medicaid expansion established through the ACA is constitutional if it is optional, thus prohibiting the federal government from penalizing states choosing not to expand Medicaid eligibility. Contraception Cases
The Supreme Court has heard three separate cases — Burwell v. Hobby Lobby, Zubik v. Burwell and Little Sisters of the Poor v. Pennsylvania —relating to the ACA’s mandate that health insurance plans cover contraception without cost-sharing. Regulations long exempted churches from the contraceptive mandate, and 2013 regulations allowed religious non-profits to participate in a “self-certification accommodation” process where employees could still receive contraceptive coverage from their health plan. Burwell v. Hobby Lobby (2014) held that privately and closely held companies with religious objections are exempt from the ACA’s requirement to provide employees with no-cost contraceptives and extended the self-certification accommodation process to these entities. In Zubik v. Burwell (2016), religious nonprofits claimed that submitting a form to their insurer or the federal government saying they object to providing contraception coverage on religious grounds violates the Religious Freedom Restoration Act. The Supreme Court did not decide this issue when the parties agreed contraceptive coverage could be provided to the nonprofits’ employees, through the nonprofits’ insurance companies, without any notice from the nonprofits. New rules in 2017 exempted all objecting religious employers (not just churches) and morally objecting non-profits and private for-profits from the contraceptive mandate.