On March 4, the US Supreme Court will hear oral argument in the case of King v. Burwell. This case challenges the Affordable Care Act’s provision of tax subsidies in states, such as Ohio, using the federally operated Marketplace. If the Court strikes down subsidies, the decision is likely to send shockwaves not only through Ohio and other states using the federal Marketplace, but through individual insurance markets across the country.  

What Ohioans – Especially Those Receiving Subsidized Marketplace Insurance – Need to Know:

Thanks to the ACA, millions of Americans – including 734,000 in Ohio – now have quality, affordable health coverage who didn’t have it before. In many states, like Ohio, that didn’t create their own state-run Marketplace, residents purchase coverage and obtain subsidies through the federal Marketplace. 234,000 Ohioans receive coverage through the federal Marketplace.

This lawsuit is another politically motivated attack on the ACA – this time, claiming that the law does not permit people purchasing coverage through the federal Marketplace to receive tax subsidies. Most legal scholars agree that there is no legal basis for the Supreme Court to take away health coverage from millions of Americans. Congress, the Congressional Budget Office, everyone – Republicans and Democrats alike – agreed that subsidies would be available through both the federal and state Marketplaces.

The Court is hearing legal arguments on March 4 and will likely make a decision by June – or even earlier. In the meantime, while the Court considers this case, people receiving subsidies will continue to receive their tax credits. They can continue using their insurance and paying their premiums as usual.

What If the Court Strikes Down the Subsidies?

Even though the lawsuit has no legal merit, the Court could still rule against the ACA. But, a Supreme Court decision in favor of the challengers would be highly political and call into question its historic independence from the political branches of government. A decision by the Supreme Court to take health coverage away from so many Americans would be unprecedented in American history.

If the Court strikes down the federal subsidies, the change will probably go into effect within a month or so. The decision will likely come in June, or even sooner. That means, to be on the safe side, people receiving subsidies through the federal Marketplace should make sure they schedule needed preventive care, tests, and treatments soon, if they cannot afford their insurance without the subsidy.

How Will Access to Affordable Insurance Be Affected?

People in states like Ohio that use the federal Marketplace would lose their subsidies. Those who could not afford to pay the full price of their insurance would soon lose their insurance. “Healthy” people would be more likely to drop their insurance than people with significant health care needs, who might find a way to purchase insurance even without the subsidy. As healthy people leave the market, insurance premiums would rise, driving more relatively healthy people from the market. That’s known in the insurance world as the “Death Spiral,” for obvious reasons.  Experts believe that loss of subsidies in states using the federal Marketplace would spill over to the individual insurance markets in all states.

For more on this gloomy scenario, see Julie Rovner’s article in Kaiser Health News.

What Can We Do to Save the Subsidies?

UHCAN Ohio is holding a press conference and using social media to raise the voice of people who care about their subsidies.  The first line of defense is making sure the Court knows that the consequences of overturning the subsidies have no easy fix.  Secondly, since Congress could pass an amendment clarifying that the ACA provides subsidies to states using the federal Marketplace, it is important to call or write your Representative and Senators. However, opposition to the Affordable Care Act makes Congressional action a major challenge. We can push the Governor and Ohio’s legislature to create a state Exchange – another heavy lift. But UHCAN Ohio will be doing all of this – hopefully with you—when we weigh the outcome of the case. Share your story with us – help us to demonstrate what affordable coverage has meant in the lives of real Ohioans.