Political games are de rigueur in Washington and the Supreme Court is no exception. With its grant of review in King v. Burwell, the nation’s highest court has set the stage for yet another Affordable Care Act showdown.
King is different from the hundreds of cases challenging nearly every facet of the ACA. The question at issue cuts to the very heart of the law. Are the ACA’s tax credits and subsidies available to people in every state, regardless of the type of marketplace setup? The answer will have enormous consequences and determine whether millions of Americans can afford to keep their health insurance.
As others have noted, Congress designed the ACA as a three-legged stool made up of the individual mandate, non-discrimination provisions and premium subsidies. In order to make health insurance available to nearly everyone, the ACA prohibits insurers from locking out people with pre-existing conditions or charging excessively high premiums based on age or health. The law compensates for the increased risk of covering people with expensive conditions by requiring nearly everyone to have health insurance. But, in order to enforce that mandate, health insurance must be affordable and accessible. This is where the tax credits and subsidies come into play.