The highest court in the United States, the Supreme Court, hears generally less than 100 cases every term. By the time a case gets to the Supreme Court, it’s been heard by the lower courts several times. In the case of King v. Burwell, it’s no different. But why are so many interested in King v. Burwell? Simply put, the case challenges the availability of tax subsidies for individuals who purchase individual health insurance on a marketplace created by the federal government--as opposed to a state-run marketplace.
Obamacare’s future hinges on the outcomes of this case. And recently, oral arguments for King v. Burwell were heard by the Supreme Court. In this ACA series on Obamacare, we’ll go over the arguments which occurred on March 4th, and what they could mean for the millions of Americans with health insurance.
A Quick History of King v. Burwell
If you’re unfamiliar with the King v. Burwell case, that’s okay. Basically, four individuals are challenging the Affordable Care Act (Obamacare) by saying the text of the law only allows for federal subsidies to be used on state-run exchanges. The problem is, premium tax credits are being used on federally-run exchanges as well. The four individuals who are challenging Obamacare say this is not legal according to the regulation as implemented by the Internal Revenue Service (IRS).
The Hearing Summary
On March 4th, the Supreme Court heard each side of the King v. Burwell case. Michael Carvin, the lawyer representing the four plaintiffs, began by telling the Justices that his case was a “straightforward case” of interpreting Obamacare. Carvin was interrupted by Justice Ruth Bader Ginsburg asking him to address the issue of “standing” -- whether the plaintiffs had a legal right to be in court at all.
According to the SCOTUS blog, Carvin and Ginsburg went back and forth before the Court for some time, but ultimately, all Justices Ginsburg, Breyer, Sotomayor, and Kagan of the Court’s more liberal Justices appeared skeptical of his interpretation of Obamacare. Some Justices gave examples from Affordable Care Act text which, to them, were clearly in conflict with Carvin’s interpretation of the law.
After several Justices questioned Carvin, Sonia Sotomayor expressed concern about the consequences of a ruling for the plaintiffs. She said that if a state’s residents don’t receive subsidies for health insurance, it would lead to a “death spiral” because so many individuals in those states would no longer be required to buy health insurance, but insurers would still be required to offer insurance to everyone and only sick people will buy health insurance. This, in turn, would cause everyone’s insurance costs to rise and many would drop out of the insurance market. Ultimately, this would make states feel forced to establish an exchange and would be in violation of the constitution, according to Justice Sotomayor.
Arguments by Justices Scalia and Alito pushed back against opposing attorney Solicitor General Don Verrilli. Both expressed that if Congress had not wanted to limit the subsidies to the residents of states that had set up their own exchanges, it could have used more precise language to do so.
The Verdict and Future of Obamacare
After a long hearing, many are wondering what the verdict will be as we await the final decision. The question is, is Obamacare in danger? Justices are not bound by their statements during oral arguments, but many pundits use the discussion as a time to gather early evidence on what a decision might look like. Based on the oral arguments, so far, the four left-leaning justices - Breyer, Ginsburg, Sotomayer, and Kagan - appear to be in favor of allowing subsidies in federal exchanges.
Justices Scalia, Thomas, and Alito will likely rule to restrict the access to premium tax credits. Which leaves Chief Justice Roberts and Justice Kennedy. After the hearing, it would appear Kennedy is in favor of the government after he expressed concern that Obamacare would not survive if the ruling was in favor of the plaintiff. As far as Chief Justice Roberts goes, it’s difficult to say what his final decision will be.
At this point, it is difficult to say what the final ruling will be in the King v. Burwell case. After the March 4th hearing where many arguments and counter-arguments were heard, the case is compelling and the question still lingers - what will happen if the Court rules in favor of the plaintiffs? Would this mean Obamacare would remain as-is with only minor adjustments? Or would it mean everything from the time Obamacare was implemented would be voided?
What do you think the outcome of the King v. Burwell case will be? Will it affect Obamacare? Comment below!