King v. Burwell – Thursday, 10 AM. Friday’s Question For Presidential Candidates: “What’s Your Plan Now?”

Posted on | June 14, 2015 | Comments Off on King v. Burwell – Thursday, 10 AM. Friday’s Question For Presidential Candidates: “What’s Your Plan Now?”

Mike Magee

According to the official blog of the Supreme Court of the United States, this Thursday at 10 AM, we can expect some decisions coming down in the much publicized case, King v. Burwell. But while many Americans have vaguely heard of the case, few understand exactly what the case is about, and what is at stake in the ultimate decision.

In a nutshell, the case, being funded by the libertarian think tank, Competitive Enterprise Institute, claims that the Internal Revenue Service exceeded the powers granted it by Congress through the Affordable Care Act (Obamacare) when it extended subsidies to help cover federally run insurance exchanges for low income Americans. In their literal reading of the law, subsidies were allowed to be granted only by state run exchanges.

Federal exchanges come into play when individual states decline to set up their own exchanges. (So far only 16 states and the District of Columbia have set up fully independent state exchanges.) Were the challenge to carry this week, subsidies would disappear in the 34 states without a state run exchange, leaving an estimated 5 million in those states in the lurch. What’s interesting is that the insurance companies in these states would still be required to provide the insurance, but the rates for unsubsidized individuals would rise and preclude participation by many. The pool of insured would shrink, broadly undermining the ACA itself.

Collapsing the program is the goal. Opponents of ACA haven’t be shy about trumpeting this, and the chorus has blared ever louder as the Presidential campaign gains steam. And while opinions vary on the value of ACA, all agree that undermining it now would be significantly disruptive, and carry with it a political cost.

This point was highlighted in the Commonwealth Fund survey released this week on the programs growing popularity. A rather remarkable 86% of Americans covered under the ACA through the exchanges or associated expanded Medicaid programs were “very” or “somewhat” satisfied with their insurance. More specifically, 91% were satisfied with the choice of doctors in the program; 77% found it easy to find a primary care doctor through the program; and 60% were able to get an appointment with the doctor within two weeks.

A second survey released by the Urban Institute last week found that fears, registered by ACA opponents, that the new insurance exchanges would result in a wholesale collapse of employer based insurance, did not prove to be true. In fact, the percentage of employees covered with health insurance provided by their employers has remained steady at 70%.

For a presidential hopeful who is opposed to the ACA, a ruling for CEI on Thursday may be met with muted cheers. Why? Because on Friday, he or she will have to figure out what to say to the millions of disenfranchised, formerly insured American citizens, and how to answer the question certain to be posed again and again on the campaign trail, “What’s your plan now?”

For Health Commentary, I’m Mike Magee