The Supreme Court hears arguments Wednesday on the latest legal challenge to the Affordable Care Act. However the nine justices rule on a challenge that hinges on four words in the expansive health care reform law, there will be clear and significant personal and policy consequences.
Some 8.6 million people signed up for individual health insurance plans for 2015 using HealthCare.gov. They live in the 37 states, including Maine, that opted not to set up their own online health insurance marketplaces under the Affordable Care Act.
Preliminary numbers showed that 87 percent of those 8.6 million people qualified for assistance from the federal government to pay their monthly insurance premiums. That assistance, on average, lowered the cost of insurance by 72 percent, to about $105 per month.
That federal assistance is what is in jeopardy depending on the outcome of the case before the Supreme Court, King v. Burwell. The plaintiffs, namely the conservative Competitive Enterprise Institute, argue that those 37 states’ residents shouldn’t be eligible for federal premium assistance because the text of the Affordable Care Act provided for tax credits only for those who purchased insurance through exchanges “established by the state.”
In Maine, nearly 75,000 people had signed up for insurance under Obamacare through the Feb. 15 end of the open enrollment period. Earlier numbers showed 89 percent of them had incomes low enough to make them eligible for federal assistance. The value of that assistance was $337 per month on average, or 78 percent of the cost of their full monthly premiums.
Mainers, on average, can buy individual insurance now for $97 per month. Before the Affordable Care Act, according to the Kaiser Family Foundation, Maine residents buying insurance in the individual market paid $282 on average.
The Congressional Budget Office projects that the number of people signing up for health insurance through Obamacare’s insurance exchanges will only grow as time goes on — meaning the number of people who depend on federal assistance to afford that insurance will continue to grow as well. The Supreme Court’s ruling could preserve critical assistance for a growing number of people, or it could throw it out.
The consequences wouldn’t stop with federal assistance, though. Since the elimination of it would put the cost of insurance out of reach for so many, fewer people would purchase insurance, meaning fewer healthy people would subsidize the costs of caring for the very ill, destabilizing the entire insurance system in the affected states. This would essentially put us back where we were before the ACA, with high numbers of people without insurance and their care (usually expensive emergency room care) subsidized by those with health insurance.
But it’s not the Supreme Court’s job to issue a ruling based solely on its potential consequences. It’s not even the court’s job this time to weigh in on the law’s constitutionality. (The justices, after all, have already done that.) In this case, the court’s job is merely to interpret a statute.
And when it comes to interpreting statutes, Supreme Court justices — including those on the court’s conservative wing — are on record advocating for statutory interpretations that take into account a law’s full context and meaning and not a few words in isolation, The New York Times’ Linda Greenhouse pointed out in a February column. In King v. Burwell, the Affordable Care Act is full of the context needed to set up a system in which residents of states that don’t set up insurance exchanges can still qualify for premium assistance. The crux of the plaintiffs’ case, on the other hand, is four words that, in isolation, would seem to undermine the full Affordable Care Act.
Of course, the law could survive a negative ruling by the Supreme Court. Congress could make a simple fix to the law. States could also set up work-around solutions that allow their residents to benefit from federal assistance and still be able to afford health coverage.
That, however, depends on policymakers who have been working to undermine Obamacare suddenly becoming cooperative. In our estimation, the likelihood is greater that the Supreme Court will rule the plaintiffs in King v. Burwell have no case.