High-stakes clash at high court over health law subsidies
Mar. 03, 2015
WASHINGTON (AP) — Insurance coverage for millions of Americans is riding on the latest politically charged Supreme Court clash over President Barack Obama's health care overhaul.
The case being argued Wednesday focuses on who's eligible for federal tax subsidies intended to make health coverage affordable. Three years after Chief Justice John Roberts saved Obama's signature health law in an epic, election-year fight over its constitutionality, the chief justice could again hold the pivotal vote on the nine-judge panel.
"This case is no less important to the future of the Affordable Care Act" than the court's decision in 2012, said Erwin Chemerinsky, dean of the University of California at Irvine law school.
The current challenge devised by die-hard opponents of the law, also known as Obamacare, relies on four words — established by the state — in the more than 900-page law to argue that the vast majority of people who now get help paying for their insurance premiums are ineligible for their federal tax credits. That is because roughly three dozen states opted against creating their own health insurance marketplaces, or exchanges, and rely on the federal healthcare.gov to help people find coverage if they don't get insurance through their jobs or the government.
In the challengers' view, the phrase "established by the state" demonstrates that subsidies are only available to people in states that set up their own exchanges. Those words cannot refer to exchanges established by the Health and Human Services Department, which oversees healthcare.gov, the opponents argued.
"The language is unambiguous," said Oklahoma Attorney General Scott Pruitt, a Republican who also has sued over the subsidies. "The feds had to do it this way if they wanted states to set up state exchanges."
Such a reading of the law would hit more than 8.5 million Americans of the 11.4 million people who the Obama administration said have signed up for private health insurance this year.
The administration, congressional Democrats and 22 states argue that it would make no sense to construct the law the way its opponents suggest. The idea behind the law's structure was to decrease the number of uninsured. The law prevents insurers from denying coverage because of "pre-existing" health conditions. It requires almost everyone to be insured and provides financial help to consumers who otherwise would spend too much of their paycheck on their premiums.
The point of the last piece, the subsidies, is to keep enough people in the pool of insured to avoid triggering a so-called death spiral of declining enrollment, a growing proportion of less healthy people and premium increases by insurers.
The 2012 case took place in the midst of Obama's re-election campaign, when he touted the largest expansion of the social safety net since the advent of Medicare nearly a half-century earlier. But at the time, the benefits of the Affordable Care Act were mostly in the future. Many of its provisions had yet to take effect.
In 2015, the landscape has changed, although the partisan and ideological divisions remain for a law that passed Congress in 2010 with no Republican votes.
Of the judges who have ruled on lawsuits over the subsidies, Democratic appointees have sided with the administration and Republican appointees have been with the challengers.
Roberts was the only justice to essentially cross party lines with his vote in 2012. Fellow conservatives were outraged and some labeled the chief justice appointed by President George W. Bush a traitor. The other four court conservatives voted to strike down the health law in its entirety.
A decision is expected by late June.
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