CHA files amicus brief urging continuation of subsidies in insurance marketplaces

February 15, 2015

Millions of people would be unable to afford health insurance if plaintiffs are victorious in the Supreme Court case of King v. Burwell, CHA argued in a friend-of-the-court brief filed late last month.

In its third review of Affordable Care Act provisions, the Supreme Court will hear oral arguments March 4, this time about whether the tax credit subsidies that help low- and moderate-income people afford health insurance should be available in federally run insurance marketplaces. The court is expected to issue its ruling in June.

Plaintiffs in the King case assert that the ACA stipulates subsidies should only be available to people in states where states opted to establish and run the ACA-enabled insurance marketplace. Currently the subsidies are available in all 50 states and the U.S. Department of Health and Human Services estimates that 85 percent of people who purchase insurance through marketplaces receive the tax credits. In states where the marketplace is operated by the federal government — currently 34 states — the subsidies would no longer be available if the court sides with plaintiffs.

"With the Affordable Care Act, our nation took a giant step forward," Sr. Carol Keehan, DC, CHA's president and chief executive officer, said at a Capitol Hill press conference on Jan. 28. "And now if this case is decided wrongly, we'll take a giant step back. It is profoundly disruptive when people who have health care coverage lose it."

Also at the press conference were several people who would potentially lose their health insurance coverage because they depend on subsidies but live in a state where the marketplace is run by the federal government.

David Tedrow of Durham, N.C., was emotional as he told his story of being diagnosed with nonalcoholic cirrhosis and advised that he needed a liver transplant. Without proper insurance, he said, he was removed from the transplant list. Later, Tedrow was able to obtain an affordable insurance plan through North Carolina's federally run insurance marketplace.

"On April 3 a miracle occurred and an angel donated their liver," Tedrow said, choking back tears. Tedrow said having health insurance through the marketplace saved his life.

According to a RAND Corp. study, 9.6 million Americans could lose their coverage if the subsidies disappear in states with a federal marketplace. The report predicts that enrollment in those marketplaces without federally subsidized products would fall by 70 percent and exchange premiums would rise as much as 47 percent due in large part to the fact that the sickest individuals would be most likely to remain in the insurance pool.

Sarah Lewis, a part-time nurse from Madison, Wis., appeared at the press conference as well, explaining that she had been uninsured for six years before becoming eligible for a plan through her state's federally run marketplace.

Rep. Sandy Levin, D-Mich., speaks at last month's Capitol Hill press conference to demonstrate support for maintaining Affordable Care Act tax subsidies. A case before the Supreme Court threatens to eliminate subsidies in the 34 states with federally run insurance marketplaces. A RAND Corp. study says without the subsidies 9.6 million people could lose coverage.

Rep. Sandy Levin, D-Mich., and George Miller, a retired Democratic representative from California, also addressed reporters at the news conference organized by ACA proponents. Both men said that as framers of the ACA, they never intended for people to be treated differently because they live in states with their own marketplaces versus one run by the federal government.

According to CHA's friend-of-the-court brief, one of at least 50 filed in the case, revoking the subsidies that make coverage possible for so many people would completely misinterpret the law.

"A statute's text must be considered not in a vacuum, but with reference to the statutory context, structure, history, and purpose," the CHA legal brief argues citing legal precedent. "The subsidies under the ACA are integral to the law's effectiveness and designed to help the most vulnerable in our society obtain health insurance." 

At the press conference, Sr. Carol added that if the court rules in favor of the plaintiffs, it would be "an incredible cruelty for people who waited so long for coverage, only to have it yanked out from under them because of where they live. And it will have profound consequences on their health and on the health of their community."


Copyright © 2015 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2015 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.