Waning public support; November’s mid-term elections; and, an upcoming review of its subsidy provisions by the U.S. Supreme Court suggest that the Affordable Care Act will remain in the news for some time. While a majority of Americans disapprove of the Act its repeal by the new Republican controlled congress is unlikely and would be met with a presidential veto regardless. The new Congress may seek to achieve a number of revisions by limiting appropriations needed to enact certain elements of the ACA. How much of an effect that will have on individuals and the law itself is unknown.
The greatest threat to the Act’s future today rests with the Supreme Court. In March 2015, in the case, King v. Burwell, the Court will review whether people obtaining health insurance through the federal health insurance exchange can receive federal subsidies for their coverage.
The case will review the Internal Revenues Service’s interpretation of the ACA’s language regarding subsidies intended to help cover the cost of health insurance purchased on federal exchanges despite what will be argued is seemingly contradictory statutory language. As it was written the ACA limits subsidies to “an exchange established by the state.” Proponents of the law indicate that the word “state” is intended to generically reflect both the federal and state governments. Opponents intend to argue that the word “state” as used in the ACA specifically pertains to one of the 50 states which comprise the United States.
Should the Court rule against the IRS’s interpretation it would jeopardize the subsidies being received by 4.6 million people in 36 states where the federal government runs the exchange. A ruling on the case is expected in June 2015.
By itself, it is unlikely that King v. Burwell has the potential to kill the entire ACA. In addition to the matter of subsidies associated with the purchase of health insurance, the case also has the potential to affect other elements of the Act including: the expansion of state operated health insurance exchanges; the future of the individual and employer mandates; and, overall affordability of health insurance throughout the country.