Hunting an elephant

“A story always sounds clear enough at a distance, but the nearer you get to the scene of events, the vaguer it becomes,” George Orwell wrote in Shooting an Elephant.

The elephant hunt begins this week as the debate over the language used in the Affordable Care Act (ACA) takes center stage in the US Supreme Court. The Justices will begin hearing arguments Wednesday in King v. Burwell. The interpretation of just six words will determine whether millions of citizens might lose access to affordable healthcare, made possible to them via federal subsidies.

The way the law was written, the subsidies, in the form of tax credits, are based on premiums for plans offered “through exchanges established by individual states”. Challengers in the case argue that means federal subsidies should only then be available in states that have set up their own exchange, rather than using the federal exchange. The government argues that in context, subsidies are allowed in all states, regardless of whether it’s the state or federal exchange that’s being used to provide coverage.

If the decision, which is expected by June, goes to King, millions of insured under the ACA could lose the subsidy that makes their care “affordable”, basically shattering the reform effort and forcing the government to change the law.  There is plenty of speculation on which way the decision could go, based on questions being asked by the Justices, as well as their decision history, but we’ll have to wait on the final decision to fully understand and prepare for the ramifications to healthcare reform.

Stay tuned.