Supreme Court Upholds Affordable Care Act—a Major Win for Women: “The ACA Is Here to Stay”

Rally in Support of the Affordable Care Act at the White House in February 2017. (Wikimedia Commons)

The Affordable Care Act (ACA), which since its 2010 passage has granted health coverage to more than 31 million Americans, has survived another day in court. In Thursday’s 7–2 decision from the Supreme Court, the justices ruled that Texas and other objecting Republican-led states had no legal standing to bring the challenge to court.

“To have standing, a plaintiff must ‘allege personal injury fairly traceable to the defendant’s allegedly unlawful conduct and likely to be redressed by the requested relief,’ ” the majority wrote. “No plaintiff has shown such an injury ‘fairly traceable’ to the ‘allegedly unlawful conduct’ challenged here.”

The key issue in the case—dubbed California v. Texas—was whether a decision by Congress in 2017 to remove the individual mandate meant the law was unconstitutional and should be completely struck down.

The ruling will have profound impacts on women, the LGBTQ community and young people, as multiple ACA provisions specifically address critical aspects of insurance coverage, including: prohibition of sex discrimination in insurance coverage and gender-based pricing; mandates of coverage for pregnancy and maternity care; coverage of birth control and mammograms without copays or deductibles; prohibition of the exclusion of preexisting medical conditions (before the ACA, preexisting conditions included domestic violence and pregnancy); provisions that allow young adults to remain on their parents’ policies; and more.

Affordable Care Act Under Constant Attack

Republicans have repeatedly tried to kill the ACA since its passage in 2010. In fact, California v. Texas was the ACA’s third appearance before the Supreme Court.

Republicans first filed a lawsuit challenging Congress’s authority to pass the law. In 2012, conservative Supreme Court Chief Justice John Roberts surprised the nation by joining liberals on the court to uphold the ACA by a 5–4 majority. He wrote for the court that the law’s penalty for failure to obtain insurance was a form of taxation, which Congress had the authority to do.

In 2015, another attempt to gut ACA failed when the Supreme Court again upheld the constitutionality of federal insurance subsidies written into the health care law—ensuring millions of Americans, especially low-income women, were still eligible for subsidies in federally facilitated marketplaces.

When Republicans took control of Congress and the White House in 2016, they pledged to end the ACA—but hoards of voters showed up at congressmembers’ offices and town halls across the nation demanding that they leave the law alone. So instead of repealing the ACA, they passed the 2017 tax law eliminating the ACA’s penalty for failure to obtain insurance, then returned to the courts to argue that removing the penalty eviscerated the constitutionality of the ACA.

In 2018, a federal district court judge in Texas agreed, striking down the entire health care law as unconstitutional.

This decision in the California v. Texas case was appealed up to the U.S Supreme Court and argued in November 2020, just one week after the election. This, of course, was one reason why Republicans were so eager to confirm Trump’s nominee for Ruth Bader Ginsburg’s seat, Amy Coney Barrett, who has made it clear she thinks the ACA is unconstitutional. She condemned Chief Justice John Roberts for having “pushed the Affordable Care Act beyond its plausible meaning to save the statute” in the aforementioned 2012 case.

However, on Thursday. Barrett, along with six other justices—Chief Justice John Roberts and Justices Brett Kavanaugh, Clarence Thomas, Sonia Sotomayor, Elena Kagan and Stephen Breyer—did not decide to strike down the ACA. Justices Samuel Alito and Neil Gorsuch dissented.

“Since the Affordable Care Act was passed, Republicans have worked breathlessly to repeal the law and take health care away from millions of Americans who depend on it,” tweeted Rep. Lauren Underwood (D-Ill.). “Today, once again, the Supreme Court upheld the ACA as the law of the land.”

What Was at Stake for Women?

Loss of the ACA would have had devastating impacts on the health of all Americans, but especially women.

Not since Title IX barred discrimination in education, opening sports to women and girls and eventually barring sexual harassment in schools, has a law had so much impact on women’s lives.

The ACA bans sex discrimination in health insurance, including gender-based pricing for insurance. The act mandates coverage for pregnancy and maternity care, and requires coverage of birth control and mammograms without copays or deductibles.

The ACA also prohibits insurance companies from declining to cover people with preexisting conditions, a practice that had put health care out of reach for millions of women. Before the ACA, pregnancy was a preexisting condition that could block access to health insurance, as were menstrual irregularities, obesity, depression, anxiety, and even a history of being a victim of domestic violence.

The ACA has significantly increased women’s access to health care. The proportion of women of reproductive age who were uninsured declined from 20 percent (12.5 million women) in 2013 to 12 percent (7.7 million) in 2018. The ACA has also saved women billions of dollars.

In 2013 alone, no-copay birth control saved U.S. women $483 million, or an average of $269 per woman.

Ending the ACA would have meant millions of Americans would lose their health care. At least 31 million people who buy insurance through the ACA marketplaces or have Medicaid through the law’s expansion could lose their health insurance coverage. People with preexisting conditions—as many as 133 million Americans—could lose their health care. That’s more than one-third of the U.S. population (and roughly half the population under the age of 65).

Earlier this month, the Department of Health and Human Services released a new report showing 31 million Americans with health coverage through the Affordable Care Act—a new record. The report also revealed the amount of people served by the health Marketplaces and Medicaid expansion has also reached a new high. Moreover, every state in the country has seen reductions in uninsurance rates in since the law’s coverage expansions took effect.

“Let me say definitively: The Affordable Care Act has won,” said Senate Majority Leader Chuck Schumer (D-N.Y.). “The Supreme Court has just ruled the ACA is here to stay. And now we’re going to try and make it bigger and better.”

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About and

Carrie N. Baker, J.D., Ph.D., is the Sylvia Dlugasch Bauman professor of American Studies and the chair of the Program for the Study of Women and Gender at Smith College. She is a contributing editor at Ms. magazine. You can contact Dr. Baker at or follow her on Twitter @CarrieNBaker.
Roxanne Szal (or Roxy) is the managing digital editor at Ms. and a producer on the Ms. podcast On the Issues With Michele Goodwin. She is also a mentor editor for The OpEd Project. Before becoming a journalist, she was a Texas public school English teacher. She is based in Austin, Texas. Find her on Twitter @roxyszal.