A general view of the U.S. Supreme Court building in Washington June 15. The U.S. Supreme Court on Monday rejected an effort by Iraq to revive a lawsuit against dozens of companies for allegedly conspiring with former leader Saddam Hussein's government to subvert the U.N. oil-for-food program and deprive Iraqi citizens of humanitarian aid.
The four words “established by the state” could come to mean the difference between affordable health insurance and no insurance to millions of people in the coming days. Those 6.4 million people probably never suspected four words could determine whether they can afford a doctor’s visit and have to put off needed care.
Those four words are the crux of the latest Supreme Court challenge to the federal Affordable Care Act, King v. Burwell, on which the court will rule by the end of this month. A ruling in favor of the plaintiffs would endanger a key mechanism in the sweeping health care law that makes health insurance affordable to millions of Americans.
Those 6.4 million people live in the 34 states, including Maine, that opted not to establish their own online health insurance marketplaces where residents could shop around for the best insurance plan and qualify for federal subsidies to defray the cost. They relied instead on HealthCare.gov — a system that mostly worked well once the federal website overcame its disastrous 2013 rollout.
They don’t receive health insurance through their jobs or through a government program. They’re low- to middle-income people who required federal assistance in order to bring their monthly premiums down to a manageable level.
They include nearly 61,000 in Maine who depend on that federal assistance to cover, on average, $337 per month of their health insurance premium, or 78 percent of the cost. Their premiums cost them, on average, $97 per month with the assistance factored in. Before the Affordable Care Act, Maine residents who bought from the individual insurance market paid $336 per month on average.
But the King v. Burwell plaintiffs argue that these 61,000 Maine residents and millions of others aren’t eligible for federal help to defray their premiums because of four words. The text of the Affordable Care Act, they argue, makes subsidies available only to people purchasing insurance from a marketplace “established by the state.”
There’s a strong argument to make that the King v. Burwell case should never have been taken seriously as a legal challenge to the Affordable Care Act. It relies on what amounts to a drafting error. It contorts an expansive federal law to mean what Congress clearly never intended. There’s enough context in other parts of the law,supporting analyses and regulations to indicate that those four words never represented Congress’ intent.
Nevertheless, policymakers must plan for a Supreme Court decision that could invalidate 6.4 million people’s assistance.
Such an outcome would likely affect more than just the 6.4 million people who receive subsidies. It could destabilize the individual insurance market in those 34 states without insurance exchanges. The Urban Institute has projected a negative ruling could force 8.2 million to join the ranks of the uninsured next year and force individual market premiums up 35 percent in those 34 states as millions of healthy people leave an insurance market rendered unaffordable. In other words, much of the Affordable Care Act — designed deliberately, with each element depending on another — could come tumbling down, likely the plaintiffs’ intent.
