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Hey, everybody.

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Welcome to module three.

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the Patient Protection
and Affordable Care Act,

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the ACA or Obamacare as some will call it,

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was signed by President Obama in 2010.

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The law really changed
the healthcare system

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in the US monumentally

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in a way we really hadn't
seen since Medicare

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and Medicaid in 1965.

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The goal of Obamacare
was to reduce the amount

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of individuals and families
without health insurance

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and provide a better path

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to health insurance for
those without insurance

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through work or through
government insurance systems,

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like Medicare and Medicaid.

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What is the ACA?

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Most of you have discussed the
ACA in other classes already.

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You'll discuss it in other classes

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that you haven't taken yet.

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The ACA was really just a
bunch of ideas put together

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in an effort to have everyone
on healthcare insurance,

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and in doing so,

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the idea was to make
coverage more affordable

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because everyone was basically paying in.

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Parts of the ACA were pretty successful.

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You'll see in the optional
readings I'll put in this week

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the success of some of it.

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Other pieces have not been so successful.

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Parts like the CLASS Act,

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which I encourage you to read about,

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which was meant to deal with kind

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of long-term care insurance
were completely eliminated.

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So one of the things that
we'll discuss this week

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are the numerous actions

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in courts to challenge
the constitutionality

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of the Affordable Care Act.

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These are numerous and ongoing.

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As you probably know,

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the Supreme Court upheld the ACA initially

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and then for a third time again in 2021.

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Is this the end of the story? No.

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There are current lawsuits
trying to undo parts

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or the total of the ACA right now.

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The first major attack on the ACA,

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probably the most significant
was on the commerce clause.

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So Congress has the power
to regulate how states deal

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with one another.

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Plaintiffs in that case argued

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that Congress did not have the power

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under the commerce clause to
enact the Affordable Care Act

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and therefore, the whole thing
should be unconstitutional

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and thrown out.

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However, the Supreme
Court declared instead

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that this was a valid
exercise of Congress's power

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to tax because we had
that initial provision

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that taxed individuals who
did not have health insurance.

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So that individual mandate
that was originally part

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of the Affordable Care Act was the reason

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why the Supreme Court
upheld the ACA initially.

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Another challenge that followed that one,

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plaintiffs argued that the plain language

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of the Affordable Care Act
provided was not plain enough

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and therefore, folks who would be eligible

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for tax credits would only be those

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who were receiving their insurance

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through state-operated exchanges.

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It would've basically hollowed
out the Affordable Care Act

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and made it, you know, not effective.

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The Supreme Court rejected that one

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and that was the second big challenge

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to the Affordable Care Act.

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In 2018, in a suit brought in Texas,

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the plaintiff said that
because the individual mandate,

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the tax had been reduced

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to zero under the Trump administration,

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plaintiffs argued that
the tax was unlawful.

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It was no longer a viable use of power.

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However, rather than ruling on
the merits of that 2018 case,

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the court said that there was not standing

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to challenge the individual
mandate to begin with.

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Standing is basically, if
you're a plaintiff in a case,

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you have to show that
you either have an injury

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or threat of injury to
be able to bring a case.

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Otherwise, you know, you
don't have a standing to come

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to court and complain about something.

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So if you don't have this harm element

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or potential harm element,

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you don't have standing
to challenge in court.

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And basically, the court said, you know,

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if there's a tax that is amount of zero,

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you're not harmed or you do not
have potential to be harmed.

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So the third big try also failed.

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There's another lawsuit pending right now,

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Kelley versus Becerra,
where plaintiffs are arguing

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that the preventative care requirements

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under the Affordable Care Act

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for insurers and health
plans is unconstitutional

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and they make arguments,

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such as the PrEP, pre-exposure prophylaxis

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to prevent HIV violates
the Religious Freedom Act.

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So probably this will be the
fourth big Supreme Court case.

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So this week is kind of about

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the landmark Affordable Care Act

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and how law and litigation
goes back and forth

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as we try to carve out parts of the law

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that some folks don't like.

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Underlying this complex legal drama,

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there's some questions

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at play that you'll see in the module.

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You know, should healthcare be a right?

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Can we get access to
healthcare if we can't pay?

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Did the ACA expand
healthcare for insurance?

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Did the ACA expand healthcare
insurance or healthcare?

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I think these are all kind

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of these philosophical questions

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that are underlying
the Affordable Care Act

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and the results thereof.

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So I'll see you in the discussion forum

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and we can talk through some
of these important matters.