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The Affordable Care Act, also known as Obamacare, survived a third major legal challenge at the U.S. Supreme Court Thursday. In a 7-2 vote, the justices rejected a lawsuit brought by 18 Republican-led states that questioned the ACA’s legality over an individual mandate penalty. Judy Woodruff speaks with Secretary of Health and Human Services Xavier Becerra about the Supreme Court's rejection.
The Affordable Care Act today survived another major legal challenge at the U.S. Supreme Court. By a vote of 7-2, the justices rejected a lawsuit brought by 18 Republican-led states, ruling that they do not have legal standing to sue.
The majority includes Justice Clarence Thomas, who was on the other side in previous cases about the law, as well as two justices appointed by former President Donald Trump, Brett Kavanaugh and Amy Coney Barrett. The plaintiffs questioned the legality of the 11-year old law enacted to make coverage available to millions of the uninsured, after Congress zeroed out the penalty for violating the act's mandate that individuals have insurance.
But Justice Stephen Breyer, who authored today's ruling, wrote that — quote — "The state plaintiffs have failed to show that the challenged provision, without any prospect of penalty, will harm them."
In dissent, Justice Samuel Alito wrote that — quote — "The ACA imposes many burdensome obligations on states in their capacity as employers. Even $1 in harm is enough to support standing."
A short time ago, I spoke with the secretary of health and human services, Xavier Becerra, about the Supreme Court's decision.
Secretary Becerra, thank you very much for joining us.
So, first of all, what does this court ruling mean for health care in this country?
Xavier Becerra, U.S. Health and Human Services Secretary: Judy, it means the fights are over, and we get to build on the Affordable Care Act.
So, 31 million Americans who have their insurance through the Affordable Care Act can rest with the peace of mind that they can continue to get covered. Seniors who get better coverage and help paying for their prescription drugs know that that's not going to end.
That 25-year-old child of yours who has insurance through your policy can stay on your policy. It means, tomorrow, the sun will shine.
You still, though, Mr. Secretary, have Republicans like the ones who are commenting today saying Obamacare, the Affordable Care Act, has been a — quote — "failure," in their view, that it's raised the cost of health care in this country.
How do you answer them?
Usually, I answer that with the facts; 31 million Americans aren't applying to pay more for their health insurance.
We're not seeing Americans rush to say, please, please, insurance company, discriminate against me because I have asthma or cancer, and it's a preexisting condition, so I don't want you to insure me.
I don't see Americans rushing to say, get rid of this law and take us back to the bad old days. And so the facts answer that very well. And if I were playing baseball, I would say, listen, three strikes, you're out. It's time to move forward.
Well, let's look at what the administration has done and what it might still do.
You have added to the subsidies available to people who would sign up for the ACA. There's been an effort to push more Medicaid, Medicaid expansion. How do you get more Americans enrolled in the Affordable Care Act?
The more they see, Judy, how affordable it can be, the more they will come on board.
So, a million Americans so far in the last few months have discovered that, if they just sign up to healthcare.gov, they are actually going to be able to afford their coverage. Many Americans have found out that they're paying less than $10 a month for the new health plan that they have for themselves or for their family.
And so what we're just going to go out there and do is build on the success. President Biden ran for office as president saying, I want to build on the Affordable Care Act. So that's what we will do.
We know there are a number of states that have not agreed, their state legislatures, their political leadership have not agreed to expand Medicaid.
What do you do to persuade them to get them to change their mind?
Well, a year ago you could have said that, and now we have some 38 states who are on board, only 12 or so who are not. That wasn't as many a year ago. It wasn't anywhere near that number five years ago.
And so, more and more, I think states are beginning to realize, if they don't want to have — incur the costs of providing emergency room care for people who ultimately can't afford to pay it all, and so, therefore, taxpayers in that state have to cover a lot of it, they will sign up for something like expanding Medicaid.
Or perhaps it's something different. We're willing to talk to states about what it takes. If they want to be innovative, they can reduce the cost care and increase coverage for more people, we're open to some good ideas.
And are you in conversation with states right now about that?
We definitely are. There are some states that have made proposals. We're talking to them about those.
At the end of the day, we're willing to talk to anyone who wants to increase coverage and reduce prices. But that's what you have got to do. You have got to increase coverage and reduce prices.
Secretary Becerra, we know that, on the campaign trail, President Biden spoke often of his plan to enact a public option in this country, but we haven't heard about that since he has been inaugurated. Where does that stand?
Well, the fiscal scorekeepers, whether it's the Congressional Budget Office or the Office of Management and Budget on the executive side, have both said that a public option saves tens of billions of dollars in health care costs.
And so where it is, is the president said he would support that. It's a matter of getting Congress to work with us to see if we can move forward and implement something like that. It does give Americans another option in terms of insurance.
So, if you don't like the private insurance coverage that you see offered by some of the private insurers, you could go toward the public option, which would be very similar to what seniors today get under Medicare.
Is there movement in that — on that?
There are a lot of conversations about that. And, as I said, the president is very supportive.
I think the president has taken the right approach. We want to get somewhere, and we will talk to anyone with good ideas. But, at the end of the day, we're going somewhere because Americans deserve to have better health care.
There's also talk about Medicare for all.
But, in all of these proposals, you need to win — the ones that require congressional approval, you have got a very close margin in the Senate. It's tied, 50/50. How do you get the votes you need to enact the kind of legislation that would reach a significantly larger number of Americans?
That's where the president has, I believe, demonstrated that he wants to reach across the aisle. He'd like to see bipartisan movement.
But he wants to see movement. And so I think you're going to see a White House that is intent on reaching out to make it work. We can't do as much without Congress weighing in when it comes to expanding health care coverage. But we can do some things.
And I know the president will work as hard as he can to get a legislative improvement. But, at the end of the day, I think he's going to let some of us at HHS do what we can with the current tools that we have to improve access to coverage and reduce prices.
But you think you can win Republican votes?
And it's a matter of just working it hard. But, at the end of the day, you do have to make progress. You can't just sit where you are. And thank God the Supreme Court, in this decisive victory, said, time to move forward.
Secretary Xavier Becerra, who is the secretary of Health and Human Services, thank you so much for joining us.
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