The Affordable Care Act, also known as Obamacare, was signed into law five years ago this month. Since then, it has been challenged in the House of Representatives more than 50 times and has already reached the Supreme Court once. Now the court is preparing to vote once again with King v. Burwell, a case that could cripple Obamacare through semantics alone. The plaintiffs have clung to a line in the bill – “[…] through an exchange established by the state” – to undermine the legitimacy of federally operated insurance exchanges and subsidies.
The justices will decide whether the plaintiffs’ interpretation of the line is accurate. “[The challengers’] reading of the text makes no sense. It is taking words out of context versus reading it all taken together,” Elizabeth Wydra, chief counsel for the Constitutional Accountability Center, told U.S. News.
A ruling in favor of the plaintiffs would eliminate subsidies for Americans whose states did not set up their own exchange – that includes 34 states – while residents in the remaining states and the District of Columbia would remain unaffected. Pundits worry that a pro-plaintiff decision would only lead to a future “two-tiered society” brought on by the widening gap in coverage between both groups of states.
According to a report by The New York Times, “If the court decides to limit federal tax credits the result could essentially be the creation of two American health care systems […] Americans could begin to have vastly different levels of access to care. It all depends on which America they happen to live in.” The division is roughly along party lines; a majority of the affected states are currently Republican-led, while those who opted to establish a state exchange are largely Democratic.
Were the court to side with the plaintiffs, millions of Americans would be left without subsidies, potentially rendering them unable to pay for insurance. The effect of a ruling against the federal government would not be limited to those who receive subsidies; individuals who buy their own insurance would also be affected. Health insurance premiums would likely soar since healthy individuals ineligible for subsidies would probably drop coverage, forcing insurance companies to increase rates in an effort to bring back revenue.
Florida residents would be among those hit the hardest; an estimated 2 million people would lose subsidies by 2016. The state’s resistance to Obamacare was manifested earlier this month when Sarasota County was forced to shut down its primary care program by next year. State officials instructed the county to stop receiving annual federal funding that accounts for $1.9 million of the program’s budget. Without the funding, and the “Federally Qualified Health Center” designation that comes with it, the program will be forced to dismantle itself after 35 years in operation. As many as 31,000 lower-income residents will be affected. City Commissioner Christine Robinson called it a crisis.
The Supreme Court’s decision on King v. Burwell is expected by late June. Supporters of Obamacare cite the justices’ siding with the federal government in a 2012 case as a positive sign, but skeptics point out that in that instance the votes were 5-4 – a slim margin. Experts say that the justices agreeing to hear the case in the first place is already an ominous sign.