JUDY WOODRUFF: Health care policy was a big topic in the presidential election.
As John Yang reports, the Affordable Care Act was back at the Supreme Court today, with
insurance coverage for tens of millions of Americans at stake.
And then William Brangham looks at what faces president-elect Biden.
JOHN YANG: Nichole Stull is at high risk for breast cancer because of her genetic profile
and family history. But the mother of five and small business owner wasn't able to afford
regular MRIs until January.
That's when she qualified for Medicaid for the first time under a provision of the Affordable
Care Act, or Obamacare. The screenings have turned up spots, but not cancer so far.
NICHOLE STULL, Idaho Resident: The fact that I'm able to go back in every six months right
now and get some peace of mind and also just make sure that it doesn't turn, before I'm
able to get my preventative surgeries, that obviously is a huge weight lifted.
JOHN YANG: That relief is under threat.
Today, supporters of the ACA rallied outside the Supreme Court, as 18 Republican-led states
and the Trump administration asked the justices in a conference call oral argument to overturn
the entire law.
That would threaten insurance coverage for more than 20 million Americans in the midst
of a pandemic. The opponents say that, in 2017, when Congress eliminated the penalty
for not buying health insurance, it made what's called the individual mandate an unconstitutional
command because it says Americans shall buy qualifying policies.
Liberal Justice Stephen Breyer challenged that argument by evoking family dynamics with
Trump administration acting Solicitor General Jeffrey Wall.
STEPHEN BREYER, U.S. Supreme Court Associate Justice: Have I ever said, or have you ever
said to someone in your family, you shall do it? But that is an entreaty, an entreaty
or a supplication, rather than threatening a punishment.
JEFFREY WALL, Acting U.S. Solicitor General: No, Justice Breyer. In my family, when I tell
my kids that they shall do things, that's a command backed by penalty.
JOHN YANG: The law's defenders say that, without the penalty, the mandate is meaningless and,
therefore, not unconstitutional.
New Justice Amy Coney Barrett questioned California Solicitor General Michael Mongan.
AMY CONEY BARRETT, U.S. Supreme Court Associate Justice: You're asking us to treat it as if
it functionally been repealed, but that's not what Congress did. Does that matter?
MICHAEL MONGAN, California Solicitor General: Your Honor, I think Congress understood how
this court had construed 5000A as a choice, and it understood that it would make the provision
effectively inoperative to zero out the tax.
JOHN YANG: The opponents say that, if that provision falls, so should the entire law,
because, when Congress passed it in 2010, lawmakers said the mandate was key to making
it work.
But former Solicitor General Donald Verrilli, defending the ACA, said experience has shown
otherwise.
DONALD VERRILLI, Former U.S. Solicitor General: There were generous subsidies to draw people
into the market, and it was easy to enroll because of the exchanges. But there was also
a stick, the tax payment, if you didn't enroll. And I don't think there's any doubt that the
2010 Congress thought that stick was important.
But it's turned out that the carrots work without the stick.
JOHN YANG: Even some court conservatives, like Chief Justice John Roberts and Justice
Brett Kavanaugh, sounded skeptical of the opponents' argument.
JOHN ROBERTS, Chief Justice of the U.S. Supreme Court: I think it's hard for you to argue
that Congress intended the entire act to fall if the mandate was struck down, when the same
Congress that lowered the penalty to zero did not even try to repeal the rest of the
act.
I think, frankly, that they wanted the court to do that. But that's not our job.
BRETT KAVANAUGH, U.S. Supreme Court Associate Justice: It does seem fairly clear that the
proper remedy would be to sever the mandate provision and leave the rest of the act in
place.
JOHN YANG: Marcia Coyle is chief Washington correspondent for "The National Law Journal."
MARCIA COYLE, "The National Law Journal": If you have the chief justice and Justice
Kavanaugh believing that there is a way to save the act, even if a majority of the court
were to find that what Congress did in 2017 resulted in an unconstitutional mandate to
buy health insurance, that they, joined with perhaps the court's three liberal colleagues,
who also seem to think similarly, would be able to sever or cut out that mandate.
JOHN YANG: The Affordable Care Act was President Barack Obama's signature domestic achievement.
Among its most popular provisions? Prohibiting insurance companies from refusing to cover
preexisting medical conditions, like Julia Raye's diabetes.
JULIA RAYE, Virginia Resident: Diabetes is actually a killer. People die from diabetes,
uncontrolled diabetes. There are points in time when I was at 600. Two weeks ago, I was
at 28. Either of those can send you into diabetic coma.
JOHN YANG: We first met Julia and her son Charles in 2015, when another Supreme Court
challenge threatened the subsidized insurance she purchased on an ACA marketplace.
Two years later, congressional Republicans nearly succeeded in repealing the law. Raye,
an auditor, now gets insurance through her job, but she credits her previous ACA coverage
with stabilizing her health and her career.
JULIA RAYE: Cutting out preexisting conditions and shutting off these types of aid, this
may curtail a person who is working their way into a viable position that will enable
or help the economy. I don't know why this keeps coming up. I don't. It's almost like
we don't care about our people.
JOHN YANG: The court's ruling is expected by next summer.
For the "PBS NewsHour," I'm John Yang.