The Affordable Care Act's Litigation Decade

Abstract

The decade of the Affordable Care Act (ACA) has been a decade in court.

The ACA is the most challenged statute in American history. The first lawsuits were filed moments after the law was enacted-on March 23, 2010-alleging that the ACA was unconstitutional.' Ten years later, the ACA is still under attack, being litigated in three Supreme Court cases within the current year alone -for a collective total of seven Supreme Court challenges in a decade. One of the pending cases is another major challenge to the statute's entire existence. Along the way, the statute has been rebelled against by the states charged with implementing it,' sabotaged by the second President to administer it, and financially starved by Congress. All of these events have fed a swirl of litigation and made for a story of unprecedented statutory resilience.

Everything about the ACA litigation-the stakes, the political and media attention, and even the number of hours of oral argument granted by the Supreme Court-has been "outsized," as one former U.S. Solicitor General aptly put it.' The breadth of the more than 2,000 legal challenges has been staggering. The litigation reveals the extensive reach of the ACA into all areas of our economy and its effects far beyond healthcare. It shows the legal complexity of a federal law that does not rely solely on the federal government to administer it but relies on states and private actors as well. And it underscores the political and practical challenges of government intervention that aims to affect not only individual behavior but also private relationships, including those between employers and employees, and between patients and healthcare providers. For some, such interventions are an unacceptable overreach.

The ACA is the most significant healthcare legislation in recent American history, at least since Medicare and Medicaid were enacted in 1965. The cases it has generated in court have, of course, shaped American healthcare and the programs that comprise it. But they also have shaped constitutional law, federalism, statutory interpretation, administrative law, and our conceptualizations of the fights and duties of states and private actors charged with implementing federal statutes.