Isabel Diaz Tinoco and Jose Luis Tinoco shop for an insurance plan under the Affordable Care Act in 201. On Friday, a federal judge in Texas struck down the health law as unconstitutional. Photo by Joe Raedle/Getty Images.
The future of the Affordable Care Act is threatened — again — this time by a ruling Decem¬ber 14 from a federal district court judge in Texas.
Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors who brought the case. O’Connor said the tax bill passed by Congress last December effectively rendered the entire health law unconstitutional.
That tax measure eliminated the penalty for not having insur¬ance. An earlier Supreme Court decision upheld the ACA based on the view that the penalty was a tax and thus the law was valid because it relied on appropriate power allowed Congress under the Constitution. O’Connor’s decision said that without that penalty, the law no longer met that constitutional test.
“In some ways, the question before the Court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote in his 55-page decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
The decision came just hours before the end of open enrollment for ACA plans in most states that use the federal healthcare.gov insurance exchange. It is not expected that the ruling will impact the coverage for those people — the final decision will likely not come until the case reaches the Supreme Court again.
Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, which oversees those insurance exchanges, said in a tweet: “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”
The 16 Democratic state attorneys general who intervened in the case to defend the health law immediately vowed to appeal.
“The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court,” said a statement from California Attorney General Xavier Becerra. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans.”
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015.
It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The Affordable Care Act touched almost every aspect of health care, from Medicare and Med¬icaid to generic biologic drugs, the Indian Health Service, and public health changes like calorie counts on menus.
The case, Texas v. United States, was filed in February. The plaintiffs argued that because the Supreme Court upheld the ACA in 2012 as a constitutional use of its taxing power, the elimination of the tax makes the rest of the law unconstitutional.
In June, the Justice Department announced it would not fully defend the law in court. While the Trump administration said it did not agree with the plaintiffs that the tax law meant the entire ACA was unconstitutional, it said that the provisions of the law guaranteeing that people with preexisting health conditions could purchase coverage at the same price as everyone else were so inextricably linked to the tax penalty that they should be struck.
Up to the Job: How San Francisco’s PRC Is Providing Work Opportunities That Turn Into Lasting Stability
Each year, PRC serves more than 5,000 clients through a wide range of programs. These include housing navigation, legal advocacy to ensure access to health and public benefits, supportive housing, job and life-skills training, and residential treatment programs.
Black Leadership Council (BLC) Advocacy Day in Sacramento. BLC works to advance meaningful change through policy engagement to unlock the full potential of Black and low-income communities. Photo courtesy PRC.
Joe Kocurek | California Black Media
Seville Christian arrived in San Francisco in the 1990s from Kansas City, Mo., a transgender woman coming from a time and place still hostile to who she was.
San Francisco offered a deeper LGBTQ+ history and a more visible community of people like her, but even in a city known for acceptance, building a stable life from scratch was no small task.
After arriving in the city, she turned to Positive Resource Center (PRC) looking for work — and for a foothold — in a new place.
“PRC gave me my first job,” Christian said. “A simple gig — passing out magazines at the San Francisco Pride Parade.”
That first opportunity marked the beginning of a decades-long relationship with PRC, one that has seen Christian grow from client to valued employee, and eventually to policy fellow.
“Today, I’ve been with PRC for 27 years, going on 28,” she said.
Helping people access employment and build sustainable careers has been a cornerstone of PRC’s mission since its inception nearly four decades ago. In its most recent annual impact report, PRC served 443 clients through workforce development services, including career counseling, educational programs, hands-on training, and job search assistance. The average wage earned by PRC clients is $26.48 per hour — approximately 38% above San Francisco’s minimum wage.
To advance this work, organizations like PRC have benefited from funding through California’s Stop the Hate Program, which provides direct support to community-based organizations leading anti-hate initiatives.
Christian’s path was not without challenges. During some rocky years, she experienced periods of housing instability and struggled with addiction. Through PRC, she enrolled in a life-skills program that emphasized using her own lived experience as a means of helping others. The program helped set her on a path toward completing an associate’s degree and ultimately launching a career in case management.
“Today, whether someone is new to the city or has lived here their whole life, I know how to help them navigate to where they need to be,” Christian said.
PRC welcomed guests to their annual Open House in April, an evening dedicated to connection, reflection, and learning more about the programs and people working every day to support San Franciscans experiencing housing instability, unemployment, and behavioral health challenges.
Each year, PRC serves more than 5,000 clients through a wide range of programs. These include housing navigation, legal advocacy to ensure access to health and public benefits, supportive housing, job and life-skills training, and residential treatment programs.
While PRC was founded to serve people living with HIV, its mission has expanded over the decades to meet the needs of people with disabilities, individuals experiencing homelessness, and those facing mental health and substance use challenges.
According to PRC’s Chief of Public Policy and Public Affairs, Tasha Henneman, some of the organization’s earliest programs remain as vital today as they were at the start.
“Our emergency financial assistance program helped more than 1,200 people this year pay rent, cover medical bills, and keep the lights on,” Henneman said. “And over 1,400 people reached out for legal advocacy, resulting in more than $2.5 million in retroactive benefits unlocked.”
Beyond direct services, PRC is deeply committed to community empowerment and policy change. Programs such as the Black Leadership Council support community leaders in advocating for systemic reform, while the Black Trans Initiative focuses on addressing the unique challenges faced by Black transgender individuals.
A recent study from the Williams Institute highlighted findings that 71% of transgender homicide victims in the U.S. between 2010 and 2021 were Black and that nearly a third of the transgender homicides during that period were confirmed or suspected hate crimes.
PRC’s direct and indirect services can be a lifeline for people experiencing hate and are an example of the resources people can get connected with through the state’s CA vs Hate hotline.
PRC is now also producing a film project that centers the lived experiences of Black trans clients, including individuals like Christian.
“Our film highlights the health journeys and lived experiences of some of PRC’s Black trans clients,” Henneman said. “Our goal is to give voice, visibility, and agency to the participants — and to bring their stories, both harrowing and inspirational, to policymakers and the broader public.”
The film, expected to be released later this year, is directed by Yule Caise, with assistant director Zarina Codes, a Black transgender San Francisco resident.
Today, Christian continues her relationship with PRC as an ambassador, reflecting on a journey that began with a single job opportunity and grew into a lifelong commitment to service.
“Sometimes I’ll be riding the bus or standing in a grocery store, and someone will come up to me from a women’s shelter,” she said. “They’ll say, ‘Oh, Miss Seville, I just want to thank you. You really helped me with what I was dealing with.’”
She paused, smiling.
“And in those moments,” Christian said, “I think to myself, “Well!.”
A single word that sums up pride in a journey to find the best in herself.
Get Support After Hate:
California vs Hate is a non-emergency, multilingual hotline and online portal offering confidential support for hate crimes and incidents. Victims and witnesses can get help anonymously by calling 833-8-NO-HATE (833-866-4283), Monday to Friday, 9 a.m.–6 p.m. PT, or online at any time. Anonymous. Confidential. No Police. No ICE.This story was produced in partnership with CA vs Hate. Join them for the first-ever CA Civil Rights Summit on May 11, 2026. More information at www.cavshate.org/summit.
Stanford Health Care Collaborates with Alameda Health System Affiliate, Expanding Access to Care in East Bay
Introduced at a community event hosted at St. Rose Hospital in Hayward, an AHS affiliate, the partnership will enhance care for nearly 400,000 residents and solidify St. Rose’s position as a cornerstone of health and healing in the East Bay.
At St. Rose Hospital in Hayward, Alameda Health System and Stanford Announce Partnership.(L-R) Mark Fratzke, COO Alameda Health System (AHS), James Jackson, CEO AHS, Richard Espinoza, chief administrative officer AHS, California Assemblymember Liz Ortega (D-San Leandro), Rick Shumway, COO Stanford Health Care (SHC), Alameda County Supervisor Elisa Márquez, and Hayward Mayor Mark Salinas. Photo by Carla Thomas.
By Carla Thomas
On April 9, Alameda Health System (AHS) and Stanford Health Care announced a new collaboration to expand access to specialized medical services across central and southern Alameda County.
Introduced at a community event hosted at St. Rose Hospital in Hayward, an AHS affiliate, the partnership will enhance care for nearly 400,000 residents and solidify St. Rose’s position as a cornerstone of health and healing in the East Bay.
The initiative marks a milestone for the region, uniting two leading institutions in a shared mission to deliver high-quality, patient-centered care closer to home. Through this collaboration, AHS and Stanford Health Care will expand rehabilitative and behavioral health services, increase use of St. Rose’s operating rooms for advanced procedures, and enhance inpatient medical-surgical units managed by Stanford Health Care physicians.
The partnership will also support the AHS/St. Rose Foundation to advance local health programs that directly benefit East Bay residents.
Alameda County Supervisor Elisa Márquez praised the collaboration’s impact on local stability.
“This hospital was on the brink of closing, and saving it became my top priority,” Márquez said. “With continued collaboration, we’ll not only strengthen St. Rose but restore vital services like labor and delivery so babies can be born in Hayward again.
“When Stanford Health Care in Santa Clara stepped up, it was a pivotal moment,” she said. Keeping St. Rose open protects the entire regional health care ecosystem.”
James Jackson, chief executive officer of Alameda Health System, highlighted how the effort builds on recent progress at St. Rose.
“In just two years, AHS has made St. Rose financially stable and thriving,” Jackson said. “We want to make sure patients no longer need to drive miles down the highway to get care.
“Our mission; caring, healing, teaching, and serving all, remains at the heart of this collaboration. While HR1 presents real challenges for health care funding nationwide, it also offers an opportunity to reimagine how we deliver care. I’m confident that, through innovation and partnership, we’ll emerge stronger than before.”
For Rick Shumway, executive vice president and chief operating officer of Stanford Health Care, the alignment between the two organizations is crucial.
“This partnership reflects exactly who we are and who we aspire to be,” he said. “Working alongside AHS and St. Rose allows us to better understand community needs and respond meaningfully. Partnerships like this will carry us forward. We’re stronger together.”
AHS Chief Operating Officer Mark Fratzke echoed the same sentiment.
“I’m excited that the communities of Hayward and S. Alameda have access to care like this, he said. “Never underestimate the power of collaborations and partnerships.”
For nearly six decades, St. Rose Hospital has served Alameda County as a community-based safety-net hospital. One of Hayward’s largest employers, it provides more than 800 jobs and 300 skilled physicians and is designated by Alameda County as a ST-Elevation Myocardial Infarction STEMI Receiving Center for heart attack care.
COMMENTARY: The Biases We Don’t See — Preventing AI-Driven Inequality in Health Care
For decades, medicine promoted false assumptions about Black bodies. Black patients were told they had lower lung capacity, and medical devices adjusted their results accordingly. That practice was not broadly reversed until 2021. Up until 2022, a common medical formula used to measure how well a person’s kidneys were working automatically gave Black patients a higher score simply because they were Black. On paper, this made their kidneys appear healthier than they truly were. As a result, kidney disease was sometimes detected later in Black patients, delaying critical treatment and referrals.
Sen. Akilah Weber Pierson, M.D (D-San Diego). File photo.
By Sen. Akilah Weber Pierson, M.D., Special to California Black Media Partners
Technology is sold to us as neutral, objective, and free of human flaws. We are told that computers remove emotion, bias, and error from decision-making. But for many Black families, lived experience tells a different story. When technology is trained on biased systems, it reflects those same biases and silently carries them forward.
We have seen this happen across multiple industries. Facial recognition software has misidentified Black faces at far higher rates than White faces, leading to wrongful police encounters and arrests. Automated hiring systems have filtered out applicants with traditionally Black names because past hiring data reflected discriminatory patterns. Financial algorithms have denied loans or offered worse terms to Black borrowers based on zip codes and historical inequities, rather than individual creditworthiness. These systems did not become biased on their own. They were trained on biased data.
Healthcare is not immune.
For decades, medicine promoted false assumptions about Black bodies. Black patients were told they had lower lung capacity, and medical devices adjusted their results accordingly. That practice was not broadly reversed until 2021. Up until 2022, a common medical formula used to measure how well a person’s kidneys were working automatically gave Black patients a higher score simply because they were Black. On paper, this made their kidneys appear healthier than they truly were. As a result, kidney disease was sometimes detected later in Black patients, delaying critical treatment and referrals.
These biases were not limited to software or medical devices. Dangerous myths persisted that Black people feel less pain, contributing to undertreatment and delayed care. These beliefs were embedded in modern training and practice, not distant history. Those assumptions shaped the data that now feeds medical technology. When biased clinical practices form the basis of algorithms, the risk is not hypothetical. The bias can be learned, automated, and scaled.
For us in the Black community, this creates understandable fear and mistrust. Many families already carry generational memories of medical discrimination, from higher maternal mortality to lower life expectancy to being dismissed or unheard in clinical settings. Adding AI biases could make our community even more apprehensive about the healthcare system.
As a physician, I know how much trust patients place in the healthcare system during their most vulnerable moments. As a Black woman, I understand how bias can shape experiences in ways that are often invisible to those who do not live them. As a mother of two Black children, I think constantly about the systems that will shape their health and well-being. As a legislator, I believe it is our responsibility to confront emerging risks before they become widespread harm.
That is why I am the author of Senate Bill (SB) 503. This bill aims to regulate the use of artificial intelligence in healthcare by requiring developers and users of AI systems to identify, mitigate, and monitor biased impacts in their outputs to reduce racial and other disparities in clinical decision-making and patient care.
Currently under consideration in the State Assembly, SB 503 was not written to slow innovation. In fact, I encourage it. But it is our duty must ensure that every tool we in the healthcare field helps patients rather than harms them.
The health of our families depends on it.
About the Author
Sen. Akilah Weber Pierson (D–San Diego) is a physician and public health advocate representing California’s 39th Senate District.
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