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Federal Appeals Court Upholds the Federal Health Care Reform Law

The Patient Protection and Affordable Care Act (ACA), enacted in 2010 by Congress after fierce debate, has been challenged by many states, organizations and individuals. On Nov. 18, 2011, the D.C. Circuit, the fourth federal appeals court to issue a decision, upheld the law; the dispute will be resolved by the Supreme Court in the 2011 term based on appeals from the 11th Circuit.


Individuals who do not have health insurance and do not want health insurance challenged the ACA, arguing that Congress exceeded its authority and imposed requirements on them in violation of the U.S. Constitution. They argue that they should not have to participate in any health insurance program if they do not want to, regardless of how that lack of coverage might unnecessarily burden government programs and skew both taxpayer costs and the costs of health care for those who do utilize private insurance.

When the ACA was enacted in 2010, 45 million Americans did not have health insurance, primarily because they could not afford it, and health care costs were outpacing the rate of inflation. Congress recognized that people were falling into financial ruin or foregoing critical medical care (or both) when faced with health care needs they could not afford to address. The problem is particularly acute among older people, who have a higher incidence of chronic health conditions and also more often find themselves on fixed or limited incomes (i.e., retirees or those nearing retirement age), and for whom an unanticipated expense poses particular problems.

AARP’s brief, submitted by AARP Foundation Litigation attorneys, pointed out that people 50 to 64 years old, who do not have employer-provided health insurance, do not qualify for Medicaid and do not yet qualify for Medicare are systematically denied coverage or are priced out of the private market because of their age or pre-existing conditions. The brief detailed the exorbitant costs of insurance — if even available — and disparities in pricing among people of various ages; studies documenting how uninsured and underinsured people suffer worse health outcomes putting a tremendous burden on government health insurance programs. It argued that the ACA provides a measured and effective response to these problems.

The appeals courts in the 6th and 4th Circuits dismissed the claims; the U.S. Court of Appeals for the D.C. Circuit actually ruled against the plaintiffs in Seven-Sky v. Holder, holding that plaintiffs’ arguments about the law’s unconstitutionality had no merit based on prior precedent regarding similar large-scale congressional action.

What’s at Stake

People age 50-64, who need to buy health insurance on the individual private market, have been especially harmed by current health insurance industry underwriting practices. That population needs more health services and is more likely to suffer from chronic health conditions than younger counterparts, yet that segment of the population faces extreme obstacles in the private market because of industry-wide insurance underwriting and rating practices that discriminate based on health status and age.

Case Status

Seven-Sky v. Holder was decided by the D.C. Circuit. The U.S. Supreme Court will have the ultimate say as it has agreed to review the decision from the 11th Circuit, which held unconstitutional the provision of the ACA requiring individuals to purchase private insurance.

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