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Why the Affordable Care Act is back before the Supreme Court, amid a pandemic

Health care policy was a major topic during the presidential campaign, and President Trump’s administration has long sought to invalidate the Affordable Care Act. But Obamacare, as it is popularly known, is now deeply woven into American health. With health insurance for tens of millions in the balance, the legislation was back before the U.S. Supreme Court on Tuesday. John Yang reports.

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  • Judy Woodruff:

    Health care policy was a big topic in the presidential election.

    As John Yang reports, the Affordable Care Act was back at the Supreme Court today, with insurance coverage for tens of millions of Americans at stake.

    And then William Brangham looks at what faces president-elect Biden.

  • John Yang:

    Nichole Stull is at high risk for breast cancer because of her genetic profile and family history. But the mother of five and small business owner wasn't able to afford regular MRIs until January.

    That's when she qualified for Medicaid for the first time under a provision of the Affordable Care Act, or Obamacare. The screenings have turned up spots, but not cancer so far.

  • Nichole Stull:

    The fact that I'm able to go back in every six months right now and get some peace of mind and also just make sure that it doesn't turn, before I'm able to get my preventative surgeries, that obviously is a huge weight lifted.

  • John Yang:

    That relief is under threat.

    Today, supporters of the ACA rallied outside the Supreme Court, as 18 Republican-led states and the Trump administration asked the justices in a conference call oral argument to overturn the entire law.

    That would threaten insurance coverage for more than 20 million Americans in the midst of a pandemic. The opponents say that, in 2017, when Congress eliminated the penalty for not buying health insurance, it made what's called the individual mandate an unconstitutional command because it says Americans 'shall' buy qualifying policies.

    Liberal Justice Stephen Breyer challenged that argument by evoking family dynamics with Trump administration acting Solicitor General Jeffrey Wall.

  • Stephen Breyer:

    Have I ever said, or have you ever said to someone in your family, 'You shall do it?' But that is an entreaty, an entreaty or a supplication, rather than threatening a punishment.

  • Jeffrey Wall:

    No, Justice Breyer. In my family, when I tell my kids that they 'shall' do things, that's a command backed by penalty.

  • John Yang:

    The law's defenders say that, without the penalty, the mandate is meaningless and, therefore, not unconstitutional.

    New Justice Amy Coney Barrett questioned California Solicitor General Michael Mongan.

  • Amy Coney Barrett:

    You're asking us to treat it as if it functionally has been repealed, but that's not what Congress did. Does that matter?

  • Michael Mongan:

    Your Honor, I think Congress understood how this court had construed 5000A as a choice, and it understood that it would make the provision effectively inoperative to zero out the tax.

  • John Yang:

    The opponents say that, if that provision falls, so should the entire law. Because, when Congress passed it in 2010, lawmakers said the mandate was key to making it work.

    But former Solicitor General Donald Verrilli, defending the ACA, said experience has shown otherwise.

  • Donald Verrilli:

    There were generous subsidies to draw people into the market, and it was easy to enroll because of the exchanges. But there was also a stick, the tax payment, if you didn't enroll. And I don't think there's any doubt that the 2010 Congress thought that stick was important.

    But it's turned out that the carrots work without the stick.

  • John Yang:

    Even some court conservatives, like Chief Justice John Roberts and Justice Brett Kavanaugh, sounded skeptical of the opponents' argument.

  • John Roberts:

    I think it's hard for you to argue that Congress intended the entire act to fall if the mandate was struck down, when the same Congress that lowered the penalty to zero did not even try to repeal the rest of the act.

    I think, frankly, that they wanted the court to do that. But that's not our job.

  • Brett Kavanaugh:

    It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the act in place.

  • John Yang:

    Marcia Coyle is chief Washington correspondent for "The National Law Journal."

  • Marcia Coyle:

    If you have the chief justice and Justice Kavanaugh believing that there is a way to save the act, even if a majority of the court were to find that what Congress did in 2017 resulted in an unconstitutional mandate to buy health insurance, that they, joined with perhaps the court's three liberal colleagues, who also seem to think similarly, would be able to sever or cut out that mandate.

  • John Yang:

    The Affordable Care Act was President Barack Obama's signature domestic achievement. Among its most popular provisions? Prohibiting insurance companies from refusing to cover preexisting medical conditions, like Julia Raye's diabetes.

  • Julia Raye:

    Diabetes is actually a killer. People die from diabetes, uncontrolled diabetes. There are points in time when I was at 600. Two weeks ago, I was at 28. Either of those can send you into diabetic coma.

  • John Yang:

    We first met Julia and her son Charles in 2015, when another Supreme Court challenge threatened the subsidized insurance she purchased on an ACA marketplace.

    Two years later, congressional Republicans nearly succeeded in repealing the law. Raye, an auditor, now gets insurance through her job, but she credits her previous ACA coverage with stabilizing her health and her career.

  • Julia Raye:

    Cutting out preexisting conditions and shutting off these types of aid, this may curtail a person who is working their way into a viable position that will enable or help the economy. I don't know why this keeps coming up. I don't. It's almost like we don't care about our people.

  • John Yang:

    The court's ruling is expected by next summer.

    For the "PBS NewsHour," I'm John Yang.

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