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Photo: Stefani Reynolds/Getty Images

The Supreme Court Thursday morning tossed aside conservatives' latest challenge to the Affordable Care Act, rejecting the Trump administration’s bid to get the entire health care law thrown out.

Why it matters: The 7-2 ruling will allow the ACA, which covers some 20 million people and has been the law of the land for 11 years, to continue operating. It also shows there are some limits to how much of the Republican agenda can be accomplished through the courts, even with a solid conservative majority.

Details: The court said Republican attorneys general did not have the legal standing to bring their lawsuit, which aimed to get the entire ACA struck down. It's the third time the Supreme Court has saved the law.

How we got here: The ACA required most Americans to either purchase health insurance or pay a tax penalty. When the law first passed, that mandate was seen as essential to making the law’s other provisions work, particularly its protections for people with pre-existing conditions.

  • In 2012, the Supreme Court upheld the mandate as an exercise of Congress' taxing power. The federal government couldn't simply require people to buy insurance, the court said, but it could tax their decision not to do so.
  • In 2017, as part of the GOP's tax cut package, Congress zeroed out the penalty for being uninsured, nullifying the individual mandate.
  • A group of Republican attorneys general then sued. The tax penalty was now gone, and all that remained was the part that said Americans had to buy insurance. So, they argued, the mandate had become unconstitutional — and the rest of the law had to fall along with it.

But the court ruled on Thursday that the states that brought the suit could not show that they'll suffer any injury from the fact that some form of the mandate is still in effect, and threw out the lawsuit as a result.

  • Justice Stephen Breyer wrote the majority decision. Justices Samuel Alito and Neil Gorsuch dissented.
  • The states' lawsuit should have been able to proceed, Alito argued. The shell of the mandate is "clearly unconstitutional, and to the extent that the provisions of the ACA that burden the States are inextricably linked to the individual mandate, they too are unenforceable," he wrote.

What they’re saying: "A big win for the American people," President Biden tweeted. "There’s no better day than today to sign up for quality, affordable health care at HealthCare.gov. With millions of people relying on the Affordable Care Act for coverage, it remains, as ever, a BFD. And it’s here to stay."

Read the full opinions.

Go deeper

Updated Jul 29, 2021 - Axios Events

Watch: A conversation on social determinants of health

On Thursday, July 29 at 12:30pm ET, Axios senior editor Sam Baker and health care reporter Caitlin Owens hosted a virtual conversation on the social determinants of health, featuring Rep. Cheri Bustos (D-Ill.) and Mary T. Bassett, director of Harvard University's FXB Center for Health and Human Rights.

Rep. Cheri Bustos discussed how Congress is working to address inequities in social determinants of health and how the pandemic exacerbated inequities in resources for care.

  • On empowering local communities to address social determinants of health: “We now are advancing [the Social Determinants Accelerator Act] in the House with the idea being, let's investigate what the social determinants are. Let's let local communities apply for that money and then have the money in that program to actually do something about it once those negative social determinants are discovered through investigation.”
  • On the pandemic’s influence on health care: “We're living in a whole new health world because of this pandemic. What we've learned is that telehealth can be an important part of somebody's health. That all of a sudden you don't have access to mass transit because you can't leave your house. It is a problem to be able to get that health care.”

Mary T. Bassett unpacked these issues from the public health perspective, focusing on equity in access to healthy living, and the current challenge of the pandemic.

  • On unequal access to care: “The 20th century saw the biggest advancements in life expectancy that have been documented in human history, but they weren't experienced equally. And that's a problem. And it wasn't just a problem of access to health care, although we all have the right to access to health care. In my view, it's also just about access to all the things that make up a healthy life.”
  • On the vaccine and mask mandates: “It is truly a case of the challenge of public health, which is the need to protect the many and the need to protect individual rights, they have to be balanced. And on that scale, public health always puts the protection of the majority of people as carrying more weight.”

Axios chief people officer Dominique Taylor hosted a View from the Top Segment with EVP & Chief Medical Officer Employer & Individual at United Healthcare Dr. Rhonda Randall where they discussed how to address health disparities through tools and initiatives.

  • On building a more sustainable, equitable health system: “Research has shown that in addition to that, there are many factors contributing to and driving our health outcomes. And ultimately, it's where we're spending our time. It's not in the doctor's offices, in our communities, in our homes and in our places of work. So things like housing, education, food insecurity and transplant, transportation and access to care are important. And those social determinants of health and advancing health equity is really integral to building that future sustainable, modern, high performing health system.”

Thank you UnitedHealth Group for sponsoring this event.

Manhattan, Westchester prosecutors request evidence from Cuomo investigation

Gov. Cuomo during a press conference in New York City on Aug. 2. Photo: Lev Radin/Pacific Press/LightRocket via Getty Images

The district attorneys for Manhattan and Westchester County on Wednesday requested evidence related to New York Attorney General Letitia James' investigation into sexual harassment allegations against Gov. Andrew Cuomo (D), according to a letter obtained by NBC News.

Why it matters: The district attorneys are investigating if alleged conduct highlighted in an independent report published by James' office that occurred in their jurisdictions was criminal in nature.

Scoop: Buzzy media startup Puck launches in beta

Puck.news

Puck, a splashy new digital media company, is coming out of stealth mode, Axios has learned. The company debuted its landing page, puck.news, on Wednesday, and will officially launch its website in September.

Why it matters: The company has been quietly building a roster of top talent, but hadn't confirmed its branding or exact business plans up until now.