The Affordable Care Act at Risk: What Does This Mean for You?

June 17, 2021
supreme court


Last revised on June 17, 2021

On June 17, 2021, the U.S. Supreme Court upheld the Affordable Care Act (ACA) in California v. Texas, a legal challenge that sought to strike down the law. This means that the ACA will remain law, and people will continue to have access to critical patient protections and health care services.

The ACA is a critical safety net for the nearly 17 million cancer patients and survivors across the U.S., including protections for people with pre-existing conditions and eliminating patient cost-sharing for essential health benefits, such as critical cancer screening tests.

Protecting Patients: The Affordable Care Act

In 2010, the Patient Protection and Affordable Care Act (ACA), also referred to as ObamaCare, was passed into law. A record 31 million people are currently receiving quality, comprehensive, and affordable health care under the ACA (HHS, 2021).

The law included key provisions that have impacted nearly all people nationwide, including:

  • Expanded Medicaid eligibility for low-income adults, up to 138% of the federal poverty level. To date, 38 states and the District of Columbia have expanded Medicaid, and 14.8 million people have gained coverage as a result (HHS, 2021).
  • Protected Americans with pre-existing conditions, including cancer. Under the ACA, health insurance companies cannot refuse to cover you or charge you more if you have a pre-existing condition.
  • Allowed young adults to stay on their parent's insurance until the age of 26.
  • Provided essential health benefits, including colorectalcervical, and breast cancer screening tests.
  • Determined that health insurers cannot set annual or lifetime limits (caps) on how much they will pay for the benefits that are covered by your plan.
  • Established health marketplaces which offers individuals and small businesses the opportunity to shop for health insurance.

From 2010 to 2018 the number of non-elderly Americans who are uninsured decreased by 18.6 million as the ACA went into effect (Tolbert et al., 2019). There is also evidence that points toward a trend in increased early-stage diagnoses for colorectal, lung, breast, and pancreatic cancer in states that increased access to health care through Medicaid expansion because of the ACA (Jemal et al., 2017).

The ACA became even more important during the COVID-19 pandemic and the subsequent public health emergency and economic downturn for millions of individuals and families nationwide. In the last 4 months alone, more than 1.2 million people have enrolled in health insurance at during the federal marketplace’s Special Enrollment Period (SEP), which runs through August 15th. Visit to shop for health care or change plans due to the public health emergency.

View this helpful checklist when shopping for insurance


What Does This Court Ruling Mean for You?

The ACA will remain the law of the land.  Patients can continue to rely on critical patient protections and access to health care coverage through the ACA. The Cancer Support Community (CSC) will expand our efforts to strengthen patient protections, improve the nation’s health care system, and address longstanding inequities and barriers that emotionally and financially impact the millions of people living with cancer and other serious medical conditions.

History of the Case

Building up to the Supreme Court

In December 2017, the U.S. Congress passed the Tax Cuts and Jobs Act into law. Among other provisions, the law effectively repealed the ACA’s “individual shared responsibility penalty,” otherwise known as the individual mandate. The mandate imposed a penalty through a tax payment for individuals who did not secure health care coverage. The penalty is effectively no longer applicable because the Tax Cuts and Jobs Act reduced the amount individuals would owe to zero. This provision of the ACA had been created to ensure that people who were both healthy and those living with chronic illnesses would purchase health care coverage to ensure a “balance in the marketplace.”  In other words, people who have not experienced illness and those living with chronic illnesses would each help to fund the health care system.

In 2018 the Texas Attorney General, along with 18 other state attorneys general, two governors, and two individuals filed a lawsuit in the state of Texas, alleging that the ACA has become unconstitutional since the lowering of the individual shared responsibility penalty. District Court Judge Reed O’Connor ruled in favor of those who filed the case who argued that because the coverage mandate was lowered to zero dollars as part of the 2017 Tax Cuts and Jobs Act, the entire law is invalid and must be struck down. This ruling was appealed, and the 5th Circuit Court took up the case. In a 2-1 decision, the 5th Circuit ruled in December 2019 that the mandate is unconstitutional, but not the whole ACAleaving the rest of the law in limbo.

The ACA at the Supreme Court

With the 5th Circuit Court ruling, the case was initially sent back to District Court Judge O’Connor, who already has held the law unconstitutional, for analysis regarding whether the ACA can stand without the individual mandate. However, California Attorney General Xavier Becerra appealed the decision to the U.S. Supreme Court. The Supreme Court agreed to hear the case, which asks whether the law’s individual mandate is unconstitutional and, if so, whether the rest of the law can remain standing.

The Supreme Court heard oral arguments in the case on November 10, 2020. On June 17, 2021, the Supreme Court decided that the states and individuals challenging the ACA do not have standing (a legal right to sue) to challenge the individual mandate, keeping the ACA in place in its entirety.

Read CSC's statement in support of the decision.


Jemal, A., Lin, C.C., Davidoff, A.J., Han, X. (2017). Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients With Cancer After the Affordable Care ActJournal of Clinical Oncology, 35:35, 3906-3915. 

Tolbert, J., Orgera, K., Singer, N., Damico, A. (2019). Key Facts about the Uninsured PopulationKaiser Family Foundation. 

U.S. Department of Health and Human Services. (2021). Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates.