The U.S. Supreme Court ruled to uphold the Affordable Care Act (ACA) on Thursday morning in a 7-2 ruling.

The ACA (colloquially known as Obamacare) is like a cat with nine lives. No matter how many times it seems ready to fall, it always lands on its feet, unhurt and unscathed.

The act was signed into law by former President Barack Obama on March 23, 2010. Since then, it has been the subject of seemingly endless legal disputes. In the 11 years, 2 months and 26 days that have since ensued, the Supreme Court has upheld the act three separate times.

In 2012, the court ruled in National Federation of Independent Business v. Sebelius that the law’s individual mandate, which included a “penalty,” was constitutional after the high court redefined the term to be a “tax,” and therefore a justified use of Congress’s taxing power.

Then in 2014, the Supreme Court again upheld the law’s constitutionality in King v. Burwell. There, the act specified that persons could buy insurance through state exchanges. However, after several states refused to do establish exchanges, the federal government decided to set up its own exchange. The court again saved the ACA by declaring the federal government a “State.”

That brings us to the court’s decision today, which in his dissenting opinion, Justice Alito terms the “third installment in our epic Affordable Care Act trilogy.”

The majority opinion was joined by both conservative and liberal justices. Justice Stephen Breyer authored the opinion and was joined by Chief Justice Roberts and Associate Justices Thomas, Sotomayor, Kagan, Kavanaugh and Barrett.

Justice Alito filed a dissenting opinion and was joined by Justice Gorsuch.

The plaintiffs in this case were Texas and 17 other states, along with individuals Neill Hurley and John Nantz. The ACA imposed a requirement that Americans purchased health insurance, with a monetary penalty for failing to do so. In 2017, the U.S. Congress passed the Tax Cuts and Jobs Act which zeroed out the penalty.

Because of this, as Justice Breyer recounts in his majority opinion, the plaintiffs “claim that without the penalty the Act’s minimum essential coverage requirement is unconstitutional. Specifically, they say neither the Commerce Clause nor the Tax Clause (nor any other enumerated power) grants Congress the power to enact it. They also argue that the minimum essential coverage requirement is not severable from the rest of the Act. Hence, they believe the Act as a whole is invalid.”

The high court did not decide this case on the merits of the plaintiffs’ arguments. Rather, the court determined that “Texas and the other plaintiffs in this suit lack the standing necessary to raise them.”

In other words, though Texas’ arguments may be correct, the court ruled against them because they were not the right entities to bring the lawsuit.

Justice Thomas, who wrote a separate concurring opinion, said that he agreed with much of the dissent.

“This Court has gone to great lengths to rescue the Act from its own text,” he wrote. “But, whatever the Act’s dubious history in this Court, we must assess the current suit on its own terms. And, here, there is a fundamental problem with the arguments advanced by the plaintiffs in attacking the Act—they have not identified any unlawful action that has injured them.”

Justice Alito wrote in his dissent that the majority’s decision in the case, along with the previous two, amounts to an “improbable rescue” of the ACA.

The justice went on to argue that the idea that none of the 17 states in the case have standing to sue is dubious since the court has afforded standing to other states in different cases.

“No one can fail to be impressed by the lengths to which this Court has been willing to go to defend the ACA against all threats. A penalty is a tax. The United States is a State. And 18 States who bear costly burdens under the ACA cannot even get a foot in the door to raise a constitutional challenge,” Justice Alito wrote in his conclusion.

“So a tax that does not tax is allowed to stand and support one of the biggest Government programs in our Nation’s history. Fans of judicial inventiveness will applaud once again. But I must respectfully dissent.”

The case is California v. Texas

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