State Attorneys General Against the Patient Protection and Affordable Care Act of 2010

Effect of the Affordable Care Act
Overview of the Affordable Care Act
The ACA in other states
Affordable Care Act glossary
Medicaid • Obamacare lawsuits • Republican effort to repeal the ACA
The data on this page was the most current data available as of October 2017.

On March 23, 2010, President Barack Obama (D) signed the Patient Protection and Affordable Care Act (ACA) into law, which was later amended by the Health Care and Education Reconciliation Act. The ACA introduced a series of changes to the American healthcare system aiming to, according to the Act’s official website, “make affordable health insurance available to more people,” “expand the Medicaid program,” and “support innovative medical care delivery methods designed to lower the costs of health care generally.” Among the law’s provisions were the imposition of penalties on some individuals who did not have health insurance, a provision often referred to as the individual mandate, and a Medicaid expansion that would provide coverage to childless adults earning incomes up to 138% of the federal poverty level, which would be financed in part by the federal government and in part by individual states.

A group of 14 state attorneys general came out in opposition to the act in December 2009 with a letter condemning a specific provision of the ACA. Though this provision was removed from the act after the law was passed, 13 state attorneys general, 11 of whom were signees, moved forward with a lawsuit challenging its constitutionality.

This lawsuit, filed on the same day the ACA was signed into law, alleged that the individual mandate and the required state Medicaid expansion were unconstitutional. By the time the suit reached the United States Supreme Court, the plaintiffs had grown to include 26 state attorneys general. The Court ultimately ruled to uphold the constitutionality of the individual mandate as falling within Congress’ authority to levy taxes and struck down the Medicaid expansion as being unduly coercive in light of the withholding of funding that would result from noncompliance.

Opposition of ACA by state attorneys general before signing

December 24, 2009: The ACA is approved by the Senate

In order to pass the Affordable Care Act, Democrats needed to secure all sixty of their senatorial votes. The version of the ACA that was approved by the Senate included a provision that said the federal government would pay in full for Nebraska’s newly eligible Medicaid enrollees, whereas other states would split funding with the federal government. Opponents of this provision said it was added to gain support from Sen. Ben Nelson (D-Neb.), who maintained that this was not the case.

December 30, 2009: 14 state attorneys general write a letter in response to Senate approval of the ACA

A week after the Senate had approved its draft of the ACA, 14 state attorneys general from Alabama, Colorado, Florida, Idaho, Michigan, North Dakota, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Virginia, and Washington, signed a letter to Democratic Congressional leadership requesting the removal of the Nebraska provision from the Senate draft of the act. The letter, organized by South Carolina’s Attorney General Henry McMaster (R), left open the possibility for further litigation. Democrats at the time said that the letter stemmed from political motivations on the part of the signees, some of whom were running in upcoming elections.

Opposition of ACA by state attorneys general after signing

March 23, 2010: The ACA is signed into law, state attorneys general file a lawsuit

President Barack Obama signed the Senate version of the ACA into law on March 23, 2010. After Sen. Edward Kennedy (D-Mass.) died and Sen. Scott Brown (R-Mass.) won his seat, Democratic leadership feared they would not be able to pass another version through the Senate having lost their filibuster-proof majority. Instead, leadership opted to make changes to the law by passing the Health Care and Education Reconciliation Act a week later, which, among its amendments, included the removal of the Nebraska provision from the ACA.

Attorneys general from Alabama, Colorado, Florida, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah, and Washington, 11 of whom signed the December letter, filed suit against the ACA the same day it was signed into law. These states were eventually joined by Alaska, Arizona, Georgia, Indiana, Iowa, Kansas, Maine, Mississippi, Nevada, North Dakota, Ohio, Wisconsin, and Wyoming. The lawsuit challenged the constitutional legitimacy of the ACA on two grounds. The first was that the individual mandate fell outside of the federal government’s authority, while the second was that the requirement for state Medicaid expansion of coverage violated state sovereignty.

January and August 2011: U.S. District Court for the Northern District of Florida and Eleventh Circuit Court of Appeals rule on ACA challenges

The case was first heard in the U.S. District Court for the Northern District of Florida by Judge Roger Vinson. He ruled that the individual mandate fell outside of the regulatory powers granted to Congress by the Commerce Clause, while also rejecting the claim that requiring states to pay for a portion of expanded Medicaid coverage violated state sovereignty. Judge Vinson concluded that the “individual mandate and the remaining provisions are all inextricably bound together in purpose and must stand or fall as a single unit.” The plaintiffs then appealed the case to the Eleventh Circuit Court of Appeals in Atlanta, Georgia. On August 12, 2011, in a 2-1 ruling, the court also found the individual mandate to be unconstitutional. In a departure from the lower court’s ruling, however, the Eleventh Circuit did not find the individual mandate to be inextricable from the ACA, instead finding that the rest of the law should stand.

June 2012: The Supreme Court rules on ACA challenges

The United States Supreme Court released its ruling on June 28, 2012. In a 5-4 opinion written by Chief Justice John Roberts, the Court upheld the individual mandate as falling within Congress’ power to levy taxes, as opposed to its Commerce Clause authority. However, the justices found the Medicaid expansion to be unconstitutional due to the withholding of funds that would follow from noncompliance with expansion.

Legal effects of the Supreme Court ruling, political responses, and subsequent litigation

As of August 2020, fifteen states had chosen not to implement the ACA’s Medicaid expansion. Constitutional scholar Samuel Bagenstos said, “This is the first time the Supreme Court has ever invalidated a condition on federal spending on the grounds that it coerced the states. That's a big deal.” Another constitutional scholar, David Kopel, wrote: “plaintiffs who wish to challenge congressional and presidential overreaching have much stronger Supreme Court precedent than they did yesterday.”

In the wake of the ruling, Democratic leadership celebrated the decision as, in the words of President Barack Obama, “a victory for people all over this country whose lives are more secure because of this law.” Mitt Romney, who was running as the Republican nominee for president at the time, said in response to the ruling, “What the court did not do in its last session, I will do on the first day if elected president of the United States, and that's to repeal Obamacare.” The 2012 lawsuit was not the final legal challenge to the ACA. In August 2020, the Supreme Court added a case to its docket brought by 18 state attorneys general, the Trump administration, and some individuals challenging the law’s constitutionality in light of the individual mandate tax being reduced to zero in 2017.

See also

• Affordable Care Act
• The Patient Protection and Affordable Care Act in the courts
• Health Care Compact