The ACA And The Courts: Litigation's Effects On The Law's Implementation And Beyond.

The Affordable Care Act's legacy extends beyond its provision of health insurance to millions of previously uninsured people and its improved consumer protections. It has also had a significant impact on the US legal system. Litigation over the law began on the day of its enactment and has been a constant in the decade since. Although the law has survived these challenges, its effectiveness has been hobbled. Litigation is now being used as a check on the efforts to undermine the Affordable Care Act by the administration of President Donald Trump. This article reviews the history of litigation over the Affordable Care Act, how the law generally has been shaped by this litigation, and what this experience might mean for the future of health reform efforts.

ACA Litigation: Politics Pursued through Other Means.

Despite its passage a decade ago, the Affordable Care Act (ACA) remains a politically divisive law. These political divisions have long been on display in Congress, in the White House, and in states. A long-standing stalemate in Congress-where Republicans cannot repeal the law and Democrats cannot improve it-has emboldened efforts by the executive branch to act unilaterally to implement, or undermine, the ACA. In turn, the law's opponents and supporters have turned to the courts to promote their favored policy agendas through both broadside attacks on the law and targeted challenges to its implementation. Litigation has become politics pursued through other means. These challenges have often been brought, or opposed, by state attorneys general and governors, with red-state coalitions facing off against blue-state coalitions. ACA litigation has also been characterized by forum shopping, nationwide injunctions, and questions about the court as a truly adversarial forum. This article briefly reviews the history of ACA litigation, discusses these legal norms in the context of the historic health reform law, and considers the implications of this history and the changing judiciary for future health reform efforts.

An Autumn Docket Heavy On Health Policy.

A spate of health policy litigation featured a challenge to the individual mandate and the entire ACA.

Health Policy Was Bustin' Out All Over.

The Trump administration refused to defend important provisions of the ACA in court and pursued rules that could open the door to less-regulated insurance options.

Market Stabilization Stalls; States Step In.

As federal efforts to stabilize the individual market foundered on abortion coverage, states adopted a variety of approaches. The 2019 payment notice broadened states' options in implementing the ACA.

Idaho's Actions Continue Challenges For ACA.

The Trump administration proposed liberalizing rules governing non-ACA-compliant, short-term coverage; responding to state guidance, Blue Cross of Idaho filed health plans not meeting ACA requirements.

Work Requirements And Conscience Protections.

The Trump administration broke from its predecessors by authorizing Medicaid work requirements. It also proposed to dramatically broaden rights to refuse to provide treatments for religious and moral reasons.

Active December Caps Historic Year For Reform.

The month brought the repeal of the individual mandate's penalties, but also 2018 enrollment numbers rivaling those of 2017.

Mandate Repeal Provision Ends Health Care Calm.

Marketplace enrollment for 2018 has been robust in the face of several obstacles, but the ACA faces a new threat after the Senate's vote to repeal the individual mandate.

ACA Open Enrollment Starts Amidst Tumult.

The Affordable Care Act continues to be buffeted by administration actions; a bipartisan market stabilization effort emerges in Congress.

Much Activity, Uncertainty Remains.

Bipartisan market stabilization negotiations gave way to a last-gasp attempt at repeal and replace; the ACA emerged intact but buffeted by uncertainty.

A Midsummer Night's Strange Reality.

After GOP efforts to repeal and replace the ACA collapsed in the Senate, attention is focused on whether cost-sharing reduction payments will continue.

Health Care Reform In The Senate's Hands.

Senate GOP hopes to act on health reform before July 4th were dashed. Meanwhile, a leaked rule would offer broad protections for employers objecting to contraceptive coverage.

ACA Replacement Battle Moves To Senate.

As the Senate struggles to craft its version of legislation replacing Obamacare, the Trump administration puts its stamp on health care regulation.

House Passes AHCA; HHS Acts On Regulations.

As the GOP worked to pass ACA repeal legislation, HHS finalized a market stabilization rule, and the debate over cost-sharing reduction payments continued.

Navigating A Post-AHCA Landscape.

With the GOP's ACA repeal-and-replace plan dead, at least for now, attention shifts to administrative action and other legislation.

Cross-Currents And Complexities Abound.

The effort to repeal, replace, and repair the ACA faces myriad policy and political challenges.

First Steps Of Repeal, Replace, And Repair.

The United States has never experienced a sea change in national health policy like that which occurred in early 2017.