Healthcare

Issues

This case asks the Supreme Court to determine the status of the Affordable Care Act (“ACA”) after Congress amended the ACA’s individual mandate in 2017. When Congress enacted the ACA in 2010, the individual mandate required individuals to maintain health insurance or pay a penalty. In 2012, the Court upheld the individual mandate as a valid exercise of Congress’s Taxing Power. In 2017, as part of the Tax Cuts and Jobs Act, Congress lowered the individual mandate’s penalty for failing to maintain health insurance to zero dollars. Texas contends that by setting the penalty for non-compliance to zero dollars, Congress rendered the individual mandate unconstitutional because it no longer is a valid exercise of Congress’s Taxing Power. Texas further argues that the individual mandate is not severable from the rest of the ACA, requiring the Supreme Court to strike down the entirety of the ACA. California disputes this. As a threshold matter, California contends that the opposing parties do not have standing to bring this claim because they have not been injured by the penalty of zero dollars. But even if they have standing, California argues that the individual mandate is constitutional. Finally, if it is not constitutional, California contends that the individual mandate can be severed from the rest of the ACA. This case, and the viability of the ACA, has drastic policy implications for the millions of Americans who rely on the ACA for their health insurance.

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Issues

This case concerns whether certain government task forces can issue binding recommendations without violating the Appointments Clause of the Constitution. The Health and Human Services (“HHS”) Department Preventative Services Task Force (“Task Force”), currently appointed by the HHS Secretary without the confirmation of the Senate, offers binding recommendations concerning mandatory coverage by employer insurance for certain preventative treatments under the Affordable Care Act. Braidwood Management contends that these recommendations by the Task Force are illegitimate because the members were not appointed by the President and confirmed by the Senate as principal officers. HHS Secretary Robert F. Kennedy Jr. argues that the current appointment procedures suffice since the Task Force is composed of inferior officers who can be reviewed and fired at-will by the HHS Secretary. This case has wide-ranging implications, from potentially altering the structure of mandated healthcare under the ACA’s insurance to affecting the long-established method by which task forces, advisory bodies, and administrative panels must be appointed.

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In 2010, Congress passed the Patient Protection and Affordable Care Act (“ACA”). The ACA, in part, provides tax credits for insurance premiums to eligible citizens that obtain insurance through “Exchanges,” which are health insurance marketplaces. The IRS interpreted the ACA to permit tax credits to all eligible citizens regardless of whether the Exchange is federally or state-run. In this case, the Supreme Court will have the opportunity to resolve whether the ACA, which grants tax credits to individuals who obtained insurance through state-established Exchanges, also extends those tax credits to federally-established Exchanges. Several Virginia residents contend that the plain text of the ACA shows that Congress only intended for state-established Exchanges receive tax credits and that the Chevron deference is inapplicable because of the unambiguous meaning of the text. The government counters that tax credits are available to “applicable taxpayers”—a status determined independent of the type of Exchange within a citizen’s state—and, also, that the Chevron deference applies because the government’s interpretation avoids creating conflicts within the ACA. This case will profoundly impact the balance of federalism, the separation of power between the legislative and executive branches, and the American healthcare marketplace. 

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This case asks the Supreme Court to determine the extent to which the 14^th Amendment’s Equal Protection Clause applies to gender-affirming healthcare for transgender minors. Tennessee’s Senate Bill 1 prohibits medical treatments intended to alleviate gender dysphoria or initiate gender transition for minors. The United States argues that the Bill violates the Equal Protection Clause by withholding medical care on the basis of a patient’s sex, or alternatively, that the Bill discriminates against a quasi-suspect classification: transgender status. Skrmetti contends that the Bill applies equally to Tennessee youth regardless of gender, that it is not motivated by discriminatory intent, and that transgender status does not meet the quasi-suspect class characteristics of being discrete, insular, immutable, and politically powerless. The case will have powerful implications for future state policies regarding healthcare and transgender care, especially for minors, in the continuing social and political conflict over LGBTQ+ rights.

Questions as Framed for the Court by the Parties

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