BREAKING NEWS: SCOTUS votes to uphold subsidies in King v Burwell

The U.S. Supreme Court voted today to uphold subsidies in King v Burwell, which determines whether the federal government can subsidize health insurance premiums for residents in states that did not establish a state health insurance exchange. There are 34 states with health insurance marketplaces operated by the U.S. Department of Health and Human Services (HHS). This decision affects roughly six million people.

The vote was upheld 6-3. The subsidies help low- and moderate-income individuals and families buy health insurance.

"Congress recognized that, without an incentive, many individuals would wait to purchase health insurance until they needed care," Chief Justice John Roberts wrote in the majority opinion. "So Congress adopted a coverage requirement to 'minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums.' In Congress’s view, that coverage requirement was 'essential to creating effective health insurance markets.'" 

Industry reactions were in favor of the ruling. See what the industry's associations and organizations are saying below.

  • "The ACA has positively impacted the field of aging services by allowing providers to create innovative, community-based approaches to help seniors stay as independent and healthy for as long as possible," commented Larry Minnix, LeadingAge president. "Today’s ruling also reminds us to once again applaud President Obama and Congress for taking on an issue that a hundred years of Congresses and White Houses had feared to tread."
  • "Physicians know that the uninsured live sicker and die younger so the AMA has been a leading voice in support of expanding health insurance access to ensure patients can get the care they require," said American Medical Association President Steven J. Stack. “The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis. The subsidies provide patients with peace of mind that they will not risk bankruptcy should they become seriously ill or injured and experience catastrophic health care costs."
  • “This is an important victory not only for proponents of the ACA, but for our health coverage system as a whole, including Medicare,” states Center for Medicare Advocacy Executive Director Judith Stein. “In addition to expanding health insurance coverage to millions of people who previously went without it, the Affordable Care Act strengthened and improved the Medicare program in a number of ways. It is time for the assault on the ACA to end, and for policymakers to support affordable health coverage for all.”
  • "This decision ensures that hundreds of thousands of direct-care workers, living in states that have federally run exchanges, will continue to have access to affordable health coverage. Direct-care workers, on average, earn about $17,000 per year, putting them just above the poverty level. For these low-wage workers, the cost of insurance is far out of reach without the tax credits that reduce the cost of insurance premiums," said Paraprofessional Healthcare Institute President Jodi M. Sturgeon.
  • "As a result of this decision, the insurance subsidies will be preserved for otherwise eligible purchasers of health insurance under the Affordable Care Act (ACA) without regard to whether they purchase their insurance on a federally established or a state established health insurance exchange. This is not, however, the end of the conversation about the ACA," said Tevi D. Troy, president of the American Health Policy Institute

Some healthcare experts, such as Dr. Ron Manderscheid, have blogged that ruling for the plantiffs in King v Burwell would have "throw(n) the entire ACA (Affordable Care Act) insurance system into national chaos."

"Up to this point, more than 80 percent of persons who have enrolled in marketplace health insurance are receiving a tax subsidy, and the majority of these persons would be adversely affected by such a decision," he wrote in his blog in Behavioral Healthcare magazine. "Clearly, we very strongly support the principle that HHS does indeed have the authority under the ACA to pay these premium subsidies."

Read the full Supreme Court opinion here.

Get more information on the direct impact of the ruling from JD Supra here.



Topics: Medicare/Medicaid , Regulatory Compliance