Washington and Lee University.
Georgetown University.
J Health Polit Policy Law. 2020 Aug 1;45(4):485-499. doi: 10.1215/03616878-8255433.
Despite its passage a decade ago, the Affordable Care Act (ACA) remains a politically divisive law. These political divisions have long been on display in Congress, in the White House, and in states. A long-standing stalemate in Congress-where Republicans cannot repeal the law and Democrats cannot improve it-has emboldened efforts by the executive branch to act unilaterally to implement, or undermine, the ACA. In turn, the law's opponents and supporters have turned to the courts to promote their favored policy agendas through both broadside attacks on the law and targeted challenges to its implementation. Litigation has become politics pursued through other means. These challenges have often been brought, or opposed, by state attorneys general and governors, with red-state coalitions facing off against blue-state coalitions. ACA litigation has also been characterized by forum shopping, nationwide injunctions, and questions about the court as a truly adversarial forum. This article briefly reviews the history of ACA litigation, discusses these legal norms in the context of the historic health reform law, and considers the implications of this history and the changing judiciary for future health reform efforts.
尽管平价医疗法案（ACA）十年前已经通过，但它仍然是一项极具争议的法律。这些政治分歧长期以来一直在国会、白宫和各州显现。国会长期僵持不下——共和党无法废除该法律，民主党也无法改善该法律——这使得行政部门采取单方面行动来实施或破坏 ACA 的努力更加大胆。反过来，该法律的反对者和支持者也诉诸法院，通过对该法律的全面攻击和对其实施的有针对性的挑战，来推动他们赞成的政策议程。诉讼已经成为通过其他手段进行的政治活动。这些挑战通常由州检察长和州长提起或反对，红州联盟与蓝州联盟相对抗。ACA 诉讼还具有选择法院的特点，即全国范围内的禁令，以及对法院作为一个真正对抗性论坛的质疑。本文简要回顾了 ACA 诉讼的历史，讨论了这些法律规范在具有历史意义的医疗改革法中的背景，并考虑了这一历史和不断变化的司法机构对未来医疗改革努力的影响。
