The Supreme Court is set to hear oral arguments in California v. Texas (called Texas v. U.S. when heard by the lower courts) on November 10, 2020. In the case, a group of state attorneys general, led by the Texas attorney general, argue the entire Affordable Care Act (ACA) should be found unconstitutional and overturned, given that a 2017 tax law set the ACA's individual mandate penalties to $0 but did not eliminate the now-unenforced individual mandate language along with them. Another group of attorneys general, led by the California attorney general, argue that the law has operated effectively since the penalties were eliminated, the mandate is severable from the rest of the law, and there are no constitutional grounds for overturning it. Here, we update previous analyses of the implications for insurance coverage, federal spending, and health care providers if the ACA is overturned. These estimates, computed using the Urban Institute's Health Insurance Policy Simulation Model (HIPSM), are based on a newly developed projection of coverage and spending in 2022 that accounts for an anticipated partial economic recovery from the COVID-19 recession. Our estimates of that economic recovery align with employment levels projected by the Congressional Budget Office for 2022.
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