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: The Supreme Court heard oral arguments for the case on Nov. 10, 2020, and a decision is expected by June 2021. King v. Burwell
The ACA provides that individuals can purchase health insurance on health insurance marketplaces, or exchanges, run by either the states or the federal government. It also authorizes a federal tax credit for low- and middle-income individuals who purchase insurance on the exchange. The plaintiffs in King v. Burwell argued that individuals who live in states using the federally facilitated exchange (or HealthCare.gov) are not eligible for health insurance subsidies because the ACA states subsidies are available for health plans purchased through, “an Exchange established by the state.” Thus, the legal question was whether states opting to use HealthCare.gov rather than operating their own exchange were considered “an Exchange established by the state.” 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.