The Supreme Court Has Upheld the ACA. The Next Frontier? Medicare for All.

As Americans who have accessed health insurance because of the Affordable Care Act breathed a sigh of relief on Thursday after a 7-2 U.S. Supreme Court ruling upheld the law for a third time, progressive politicians and campaigners set their sights on a more ambitious goal: Medicare for All.

“The court’s decision to not overturn the ACA and throw 31 million Americans off their healthcare is welcome. But it’s not enough,” tweeted Sen. Bernie Sanders (I-Vt.), a lead congressional advocate of implementing a single-payer system in the United States.

The U.S. Department of Health and Human Services earlier this month revealed that a record 31 million people have health coverage through the ACA, which health justice advocates have long criticized as inadequate while Republican political leaders have repeatedly attacked it with lawsuits — including Supreme Court challenges in 2012 and 2015.

The Urban Institute recently estimated (pdf) that striking down the 2010 law, also known as Obamacare, would leave over 21 million people uninsured.

“Healthcare is a human right, not a privilege,” Sanders declared Thursday. ​“We must join other major countries in guaranteeing healthcare for all and pass Medicare for All.”

That message was echoed by the groups Healthcare-NOW and Social Security Works, as well as Michael Lighty, who is currently head of the state single-payer coalition Healthy California Now and has spent the past three decades fighting for Medicare for All.

“It’s good that the question of ACA constitutionality is settled” because now, rather than defending or even taking a position on the law, progressive campaigners ​“can move on from that and build, going forward, a better system,” Lighty told Common Dreams.

“And the only place to move is toward an improved and expanded Medicare for All,” he said. ​“We can instead go to a system that will actually guarantee healthcare to everybody, which the ACA does not do and cannot do.”

In a majority opinion (pdf) written by Justice Stephen Breyer, the high court concluded that the Republican plaintiffs did not have the standing to challenge the ACA’s minimum coverage requirement ​“because they have not shown a past or future injury fairly traceable to defendants’ conduct enforcing the specific statutory provision they attack as unconstitutional.”

Right-wing justices Samuel Alito and Neil Gorsuch dissented. The court declined to address the broader question of whether the ACA is legal without a provision—killed by the GOP-controlled Congress in 2017 — that imposed a tax penalty on those who did not meet the coverage mandate.

President Joe Biden celebrated Thursday’s ruling in a tweet that referenced what he said when former President Barack Obama signed the ACA into law over a decade ago. Biden, then vice president, was caught on a hot mic telling him, ​“This is a big fucking deal.”

Lee Saunders, president of the labor union AFSCME, concurred, calling the court’s decision ​“a huge victory — for basic fairness, for the rule of law, and especially for those who would have been cruelly stripped of their healthcare during a once-in-a-century global pandemic.”

“Working families can rest a little easier tonight, with the peace of mind that they can access healthcare when they need it, that they won’t be bankrupted by a medical emergency, that they won’t be denied coverage based on a preexisting condition,” Saunders said. ​“Now, let’s work together to strengthen the ACA and build on its successes.”

Campaigners including Lighty argue that the ACA isn’t working for everyone and the path forward must now be toward a Medicare for All approach that ensures healthcare as a human right rather than providing subsidies to the private insurance industry.

“The ACA can never create health equity, since it makes profits and commercial insurance the basis of coverage. In light of the pandemic we must focus on saving lives and establishing health justice,” Lighty said.

He also emphasized that ​“we can’t rely upon the Supreme Court. This is a political task and our job is to organize a broad movement for health justice that’s connected to the broader social justice movement — and only if we understand these connections between healthcare and housing, and jobs, and the climate crisis, will we have a movement that can actually prevail regardless of what the Supreme Court does.”

However — although polling shows Medicare for All is popular with the American public — with a Senate only narrowly controlled by Democrats and a president who hasn’t committed to pushing for a single-payer system, its legislative future is uncertain.

The next step, according to Lighty along with various elected officials and advocacy groups, is Medicare expansion: lowering the eligibility age from 65; capping out-of-pocket costs; and adding dental, hearing, and vision benefits — which could all be paid for by letting the federal government negotiate drug prices with the pharmaceutical industry.

Such reforms can be accomplished even without support from GOP lawmakers — if Democrats are willing to use the budget reconciliation process, which bypasses the Senate filibuster.

That process only requires the support of 50 Democratic senators. If Democrats in Congress don’t understand the value of Medicare expansion, ​“they’re really not paying attention to what people in the U.S. need,” said Lighty. ​“That’s our first, best step toward Medicare for All.”

This story first appeared at Common Dreams.