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U.S. Supreme Court case challenging the constitutionality of the Affordable Care Act, a law that greatly expands access to health insurance for millions of Americans, including those living with HIV.


In March 2010, the Patient Protection and Affordable Care Act, commonly referred to as the ACA, was signed into law. The law reforms aspects of the private health insurance industry and expands access to health insurance for millions of Americans. The constitutionality of the law was immediately challenged in federal court in multiple jurisdictions; the United States Supreme Court will hear the appeals in these cases during its 2011-12 term and has scheduled oral argument for March 2012.

Because of the importance of the this legislation to people living with HIV, Lambda Legal filed a friend-of-the-court brief with the U.S. Supreme Court on behalf of sixteen national HIV advocacy organizations in support of the federal government’s position that the ACA’s minimum coverage requirement (also known as the individual mandate) is constitutional under the Commerce Clause and the Necessary and Proper Clause. The ACA’s interconnected reforms include expanded Medicaid coverage, elimination of pre-existing condition exclusions, and the minimum coverage requirement. These reforms are essential to expanding care and prevention strategies in the fight against the HIV/AIDS epidemic.

In 2006, Massachusetts enacted health care reform legislation similar to the ACA, featuring a minimum coverage requirement and nearly universal access to insurance, including for people with HIV. Between 2005 and 2008, Massachusetts had a 37% decrease in HIV infections while the nation had an 8% increase. Expanded access to health coverage has allowed Massachusetts to focus its federally-subsidized HIV/AIDS programs more on preventive care and related services and less on primary care and the complications associated with an AIDS diagnosis. These changed circumstances in Massachusetts foretell what the nation can expect once the ACA is fully implemented.

    • March 2010 The Patient Protection and Affordable Care Act signed into law by President Barack Obama.
    • January 2011 U.S. District Court for the Northern District of Florida declares the law’s individual mandate provision unconstitutional.
    • August 2011 The 11th Circuit Court of Appeals affirms lower court’s decision.
    • November 2011 The U.S. Supreme Court agrees to hear the case and schedules oral arguments for March 2012
    • January 2012 Lambda Legal files friend-of-the-court brief
    • March 2012 The U.S. Supreme Court hears oral argument.
    • June 2012 Court upholds most provisions of the ACA. The individual mandate is declared constitutional, based on the power of Congress to levy taxes, not because of its power to regulate interstate commerce. The Court also upholds the expansion of Medicaid, but rules that Congress may not condition receipt of all Medicaid funds upon participation in the expansion.