Keeping up with SCOTUS: King v. Burwell decision
As you’re likely well-aware, the U.S. Supreme Court handed down its decision on King v. Burwell last week. The 6-3 ruling upholds subsidies in states that utilize the federally run health insurance exchange under the Patient Protection and Affordable Care Act (PPACA).
So, what led to this decision? It all came down to phrasing. Opponents of the Affordable Care Act argued that wording within the law, “through an exchange established by the state,” permitted subsidies only in states that established an exchange. If this were indeed the case, 34 states that did not establish an exchange would be left out. Studies indicated that 6.4 million people would have lost subsidies.
Writing for the majority, Chief Justice Roberts said that by getting rid of the subsidies, the individual insurance market in states that did not establish health insurance exchanges under the PPACA would send the insurance market into the “death spirals” the law was design to avoid.
"It is implausible that Congress meant the Act to operate in this manner," wrote Chief Justice Roberts.
Chief Justice Roberts also focused on the purpose of the Affordable Care Act as support for the majority opinion. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter," he wrote.
This isn’t the first time the PPACA has been challenged, and it certainly won’t be the last.
Looking to 2016, and specifically the 2016 primary election, candidates will likely use the Affordable Care Act as a primary element of their campaign platform. Republican parties will continue to lobby for the repeal of the act to coincide with GOP popular opinion. Democratic candidates will push for continued support of the bill, likely citing King v. Burwell with the argument that they won’t take away anyone’s access to insurance.
And, what does this mean for the healthcare industry as a whole?
As Chief Justice Roberts explained, if Thursday’s decision would have gone the other way, there would have been serious repercussions, such as a great deal of people no longer being able to afford their insurance. It’s also likely that a great burden would have been put on hospitals, which would have had to pay millions in additional uncompensated care.
Industry stakeholders will continue to keep a mindful eye towards the PPACA and any movement around the law in the future.