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1 1 (September 14, 2021)

handle is hein.crs/goveemv0001 and id is 1 raw text is: Congressional                                             ______
~Research Service
Affordable Care Act Litigation Still on the
Docket After California v. Texas
September 14, 2021
Referred to as the most challenged statute in American history by some commentators, the Patient
Protection and Affordable Care Act (ACA) has been the subject of numerous lawsuits since its enactment
in 2010-more than 2,000 by one estimate. In June 2021, the Supreme Court dismissed the latest
challenge that threatened the entire law's existence in California v. Texas, leaving the law intact. The
dismissal also preserves other suits challenging particular ACA provisions or the Act's implementation,
and these cases may have implications for health insurers, health care providers, employers, patients, and
others. This Legal Sidebar provides relevant background on private health insurance requirements in Title
I of the ACA, discusses several notable past or pending ACA cases, and concludes with select legal
considerations for Congress.
ACA Private Health Insurance Requirements: Background
As the Supreme Court has recognized, Congress enacted the ACA to increase the number of individuals
covered by health insurance and decrease health care costs. Among the ACA's key features, Title I adopts
several private health insurance market reforms designed to promote access to health coverage and protect
consumers against discriminatory insurance practices. These reforms include limitations on preexisting
condition exclusions; a bar on lifetime and annual benefit limits; coverage of certain essential health
benefits; a prohibition on health insurance rescissions (except under limited circumstances); and coverage
of preventive health services without cost sharing. To facilitate health insurance enrollment, the ACA
required the creation of an insurance marketplace-or Exchange-in each state. The law also imposes
various requirements on plans sold on the Exchange to help ensure their quality and affordability.
Additionally, to assist individuals in purchasing health insurance on an Exchange, the ACA provides that
certain lower- and moderate-income taxpayers may receive federal subsidies to help offset the cost of
coverage. Some of the most prominent ACA litigation has been over Title I of the Act, including the cases
discussed below.
Congressional Research Service
https://crsreports.congress.gov
LSB10641
CRS Legal Sidebar
Prepared for Members and
Committees of Congress

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