Earlier this month the Supreme Court heard arguments for and against the controversial Patient Protection and Affordable Care Act. King v. Burwell, expected to be decided this June, will be the third time the Supreme Court will decide on the law in its brief five-year history.
In 2012, the court narrowly upheld the law’s individual mandate, while last year it decided that not all businesses are required to cover contraception for their employees.
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In King v. Burwell, the issue at hand is whether or not the IRS has the authority to provide subsidies for people to buy health insurance who do not live in states with exchanges of their own. Health care exchanges are marketplaces, mostly via the Internet, where people who do not have insurance can shop for plans. They can be run either by states or the federal government. As of now, only 16 states have opted to run their own insurance exchanges. This means all others must rely on the federal exchange to receive “Obamacare” plans. Supporters of the case say that the way the law is written, the IRS does not have the authority to provide subsidies to people who don’t live in states with exchanges — roughly 70 percent of the country. The 2012 rule, challengers say, was created by the IRS in order to ease fears that states would not create their own exchanges before the 2014 deadline.
The case involves four Virginians, all eligible for health insurance subsidies, who are trying to deny such subsidies. Should the subsidies not exist, they would not be required to pay the individual mandate penalty due to their low incomes. The plaintiffs, backed by the Competitive Enterprise Institute, a libertarian think tank, essentially believe that the government is unlawfully coercing them to buy health care they do not want.
Obama administration officials counter that this case is politically charged. They claim that an accurate reading of the law makes clear that subsidies are to be made available in all exchanges, regardless of who is running them. To them, the IRS subsidies are just a way to meet the law’s goal: to insure as many people as possible in America.
Much is at stake should the IRS rule be overturned. Every state without an exchange could be affected. Estimates say that nearly 8 million people may lose the insurance they have now: tens of thousands of whom live here in Ohio. In a statistic released by the Department of Health and Human Services, nearly 250,000 Ohioans have signed up for “Obamacare.” A majority of people at risk will be low- to middle-income Americans, many of them healthy, leaving the sickest patients to pay much higher rates. As it stands now, the subsidies provided are directly paid to health insurance companies, and then the savings are passed on to consumers. This translates to about a 75 percent decrease in premiums for recipients. Should the subsidies be rescinded, health insurance companies may not have the money to cover people with pre-existing conditions, or be able to cover young adults who stay on their parents’ plans until they are 26.
A quick fix to the rule being overturned will be an uphill battle. Congressional opponents of the law say Congress may provide financial relief to those losing subsidies, but such a measure would only be temporary and details are sketchy. States could still set up their own exchanges, ensuring their enrollees would get federal subsidies, but it would be an expensive and politically difficult process.
The verdict in the case is expected to be close. Eyes will be on Chief Justice John Roberts, who is considered to be a swing vote. He played a key role in the court’s decision to find the law’s individual mandate constitutionally legal. The court did accept to rule on this case rather quickly, a fact that further proves how contentious the law is.
Ben Osburn can be reached at letters@tfpmay.toledowebdesigns.com.
