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: 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. These new rules made the self-certification accommodation process optional for these employers. In Little Sisters of the Poor v. Pennsylvania (2020), the Supreme Court upheld the 2017 rules expanding exemptions from the coverage mandate. State Legislative Actions Safeguarding the ACA
Several states have incorporated parts of the ACA into state law, such as codifying the federal law’s consumer protection provisions or establishing a state-level individual mandate. Consumer Protections
Although some states had existing state laws establishing various consumer protections prior to and during the implementation of the ACA, at least 19 states have codified some or many of the ACA’s consumer protection provisions into state statute since 2018. These protections include guaranteeing health coverage for individuals with preexisting conditions, prohibiting insurers from varying premium rates based on an enrollee’s health-status, requiring coverage for the 10 essential health benefits, establishing cost-sharing protections and various other provisions.