ACA Implementation: The Court Challenges
Jane Perkins* and Dipti Singh**
In 2012, the United States Supreme Court upheld the constitutionality of
the Patient Protection and Affordable Care Act (ACA).
1 The Court’s deci-
sion did not, however, bring an end to litigation against the ACA, and the
judicial system remains clogged with cases.
This article provides an overview to ACA litigation, dividing the litigation into three rounds. Round One, summarized in Section II, covers litigation that culminated in the 2012 Supreme Court ruling. Almost uniformly,
that litigation sought to repeal the ACA in its entirety. Section III discusses
the second round of litigation, comprised of cases filed since the 2012 decision and dominated by cases seeking to curtail an ACA requirement for
health insurers to cover contraception without cost sharing. Notably, there
have been a large number of such cases (approaching 100, to date), and the
Supreme Court has agreed to decide whether for-profit businesses have religious rights entitling them to an exemption from the contraceptive coverage requirement. Finally, Section IV introduces an emerging Round Three.
In contrast to previous court activity, Round Three litigation seeks to enforce the ACA so that its benefits can be realized.
II. ROUND ONE: LITIGATING TO REPEAL
President Obama signing the ACA into law on March 23, 2010 un-
leashed an aggressive use of the court system by individuals and entities ob-
jecting to the law. The first lawsuit was filed within minutes after he signed
2 By the end of the day, three cases were pending.
3 Within a few
J. D., Legal Director, National Health Law Program; Senior Attorney, Network for
Public Health Law-Southeast Region, Carrboro, North Carolina.
J. D., Staff Attorney, National Health Law Program, Los Angeles, California.
1. See Nat’l Fed’n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566 (2012).
2. Kevin Arts, Legal Challenges to Health Reform: An Alliance for Health Reform
Toolkit (May 18, 2010),
3. See Nat’l Health Law Program, ACA LITIGATION—Closed Case Docket Mar. 2010-
Dec. 2012 (NFIB Linked) (last updated Jan. 10, 2013), http://www.healthlaw.org/