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Should Supreme Court limit Obamacare subsidies to state-created health exchanges? No: Mean-spirited interpretation would deny millions coverage

Millions of Americans only recently rescued from worry and hardship by acquiring health insurance now face losing it because Obamacare’s foes won’t end their obsessive opposition.

The latest threat to the Affordable Care Act is a Supreme Court case, likely to be decided in June, that will determine whether all Americans are eligible for the subsidies that make coverage affordable. The court should allow working families all across the country to keep their life-saving subsidies.

The case turns on the kind of technicality that only a lawyer could love. The law says citizens are eligible for subsidies purchased through health insurance exchanges established “by the state.”

Because of intense ideological hostility, 34 state governments betrayed their uninsured residents and refused to set up exchanges. In those cases, the law called for the federal government to set up exchanges for the states.

Obamacare’s implacable enemies are arguing that only Americans who were lucky enough to live in the 16 states that set up their own exchanges are eligible for subsidies, thereby excluding those who live in two-thirds of our country.

Since 85 percent of purchasers need subsidies to make insurance affordable – the subsidies cut monthly premiums on average from $346 to $82 – that nonsensical, mean-spirited interpretation would deny millions of working Americans decent health insurance.

That’s not what Congress intended when it passed the most sweeping reform of American health care in nearly 50 years. It didn’t mean to punish millions of citizens by denying them health insurance because of what state they live in. The architects of reform – the chairmen of the relevant committees – confirmed this obvious truth in a recent op-ed.

And it’s not only the 5 million Americans losing coverage who will suffer if the Supreme Court rules against national subsidies. The whole system will risk collapse as healthier enrollees succumb to the cost squeeze first and drop out, leaving sicker, more desperate, more expensive clients behind. Other components of the law – such as the one requiring large employers to offer coverage to their workers – could also be questioned in states that didn’t establish their own exchanges.

Trying to downplay the impact of a potential decision that would cut off millions of Americans from their health insurance, some Obamacare opponents claim states would quickly set up their own exchanges in response.

But there’s no sign that irrational hostility has weakened much to the law – even as millions of Americans experience its benefits, and besides, the vast majority of state legislatures will be out of session by the time the high court rules in June, so no quick fix will be available.

Another answer would be to change the law to remove any uncertainty about who’s eligible for subsidies, but of course the new GOP majority in Congress is too busy trying to repeal the law altogether to usefully amend it.

Indeed, the current legal attack on the Affordable Care Act is only part of an unrelenting five-year campaign of opposition, one that will presumably continue regardless of the court’s decision in this case. There’s no clear historical precedent for so much time, effort and emotion being poured into resisting an improvement in the material well-being of fellow citizens.

Think how American health are could be improved if all that angry passion was redirected into fruitful cooperation! Not even its biggest supporters are content with the Affordable Care Act as it is. Health care is still too expensive, too many people are still left out, health outcomes are still disappointing.

But we can’t address those problems until fiery Obamacare opposition cools. The Supreme Court can help the process along by acknowledging that Congress intended for all Americans – not just those living in certain states – to have access to affordable health care.

William Rice is a policy specialist with Americans for Democratic Action, the nation’s oldest liberal advocacy organization. He holds a bachelor’s degree in history from the University of Maryland.