The Milbank Quarterly  |  June 29, 2021

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On June 17, 2021, the Supreme Court upheld the Affordable Care Act (ACA) for the third time in California v. Texas, in what Justice Alito called, in dissent, “the third installment in our epic Affordable Care Act trilogy.” The first two rulings were decided by narrow majorities—by 5-4 in 2012 and 6-3 in 2015. But this time the Act survived with a 7-2 majority—with the Court’s most conservative justices dissenting (Justices Alito and Gorsuch). Eighteen states (all Republican-led) and two individuals had challenged the constitutionality of the ACA’s minimum essential health insurance coverage provision (the “individual mandate”), arguing that the whole Act was unconstitutional. The Court dodged the merits of the plaintiffs’ argument, instead ruling that they lacked the standing to sue, in a decision President Biden called “a big win for the American people.”

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