King v. Burwell Background
By the end of June 2015, the Supreme Court is expected to decide the case King v. Burwell, which will determine whether the Affordable Care Act’s (ACA) premium assistance for low- and moderate-income individuals extends to those buying health insurance in federally-facilitated marketplaces.
Under the ACA, individuals whose income is below $46,680 may qualify for lower monthly premiums for health insurance coverage purchased in the marketplace. Currently, individuals who live in states with a State-Based Marketplace, a State-Partnership, or a Federally-Facilitated Marketplace are all eligible for the lower monthly premiums. More information is available here.
Following is some background in advance of the Supreme Court’s decision.
What’s at issue in the case?
The Plaintiffs (King) argue that, as written, the ACA only gives the government authority to provide premium tax credits to individuals who live in state-based marketplaces. They claim that low- and moderate income individuals living in states with a federally facilitated marketplace do not qualify for premium tax credits. The administration argues that the record makes clear that Congress intended for the ACA to provide tax credits in both the federal marketplace and the state marketplaces.
What happens if the Court rules in favor of the Plaintiffs?
A lot will depend on what the Court’s ruling actually says. However, if the Court sides with the Plaintiffs, individuals who currently reside in Federally-Facilitated Marketplaces AND who receive financial assistance are at risk of losing that assistance. These individuals will still be eligible to keep their health care coverage, but given that their incomes are low to moderate, it is unlikely they will be able to afford their health insurance premiums.
How many people are at risk of losing their tax credits?
Estimates vary. However, the Kaiser Family Foundation has estimated that for 2016, over 13 million Americans are at risk of losing their financial assistance if the Supreme Court sides in favor of the Plaintiffs. (State-by-state estimates from the Kaiser Family Foundation are available here.)
What is ACS CAN doing about this?
ACS CAN has been closely following the litigation since its inception. ACS CAN – in conjunction with the American Heart Association, the American Diabetes Association, and the National MS Society – filed an amicus (“friend of the court”) brief in which we strongly urged the Supreme Court to retain the financial assistance for all individuals who qualify, regardless of their marketplace. A copy of the brief is available here.
We are anxiously awaiting the Supreme Court’s final decision and are preparing additional materials to be made available once the Court’s ruling is released. Depending on the final outcome, there may be additional tactics and strategies to employ. We will keep you informed as things progress