What does Obamacare actually do and when will the supreme court rule on it?

The supreme court on Tuesday will hear oral arguments in a challenge to the Affordable Care Act (ACA), the health law popularly known as Obamacare. It is the third time the supreme court is considering a challenge to the law, which was passed in 2010.

What does the ACA actually do?

At 2,000 pages, the ACA is stuffed with provisions which have fundamentally shifted the ways hospitals, doctors and insurance companies operate. It has also shifted consumer expectations.

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If it was struck down, about 21 million people would be at risk of becoming uninsured. Those who retained their insurance would lose things such as receiving preventive care like vaccinations, at no cost and people 26 and under would no longer be able to get coverage from their parents’ health insurance.

At risk is also one of the most popular parts of the law: protections for people with pre-existing conditions.

Before the ACA passed, millions of Americans who had cancer, multiple sclerosis or other diseases could be denied healthcare coverage because of their condition. At least 54 million people have a pre-existing condition which would have been deniable before the ACA.

Is the supreme court really deciding whether or not to dismantle a 2,000-page law?

Yes, but they have to answer two questions before they can respond to that one.

First, the court is tasked with deciding whether the lawsuit even has standing.

Then, they must rule on a crucial question: is the individual mandate, which requires people to be insured or pay a penalty, constitutional? In 2017, a Republican-controlled Congress made the penalty zero dollars, prompting the lawsuit.

If the court decides the individual mandate is not legal, the justices must also decide whether the individual mandate can be separated from the law or if its unconstitutionality means the rest of the law is also invalid. To understand how justices are feeling about this in the oral arguments, be on the lookout for the word “severability”.

How does this affect the Covid-19 response?

We don’t know what the pandemic will look like when the ruling comes down. We do know that if the ruling dismantles Obamacare, it could put people who have had Covid-19 at risk of losing health insurance coverage should the illness be considered a “pre-existing condition”.

They could also be charged higher premiums, or have future treatment for coronavirus turned down. The Commonwealth Fund estimated 2.3 million people aged 20 to 39 who had no underlying conditions but contracted Covid-19 would therefore be vulnerable to losing coverage for having a pre-existing condition.

When will it be decided?

The supreme court usually doesn’t rule on major cases like this until the end of its term in June.

Between today and then, Joe Biden is set to be inaugurated as president and two Georgia run-off elections will determine whether the Democrats or Republicans have control of the Senate. Both these things will affect how the country moves forward from the court’s ruling.

Who is involved?

Officials from several states, led by Texas, brought the lawsuit and will have 20 minutes to argue before the court. They will split their argument time with lawyers from the US justice department, which under Donald Trump has backed the repeal of Obamacare.

Officials from California are defending the law and will share one quarter of their argument time with lawyers representing the US House of Representatives.