Supreme Court upholds federal ACA subsidies

The Supreme Court has announced its decision in the case of King v. Burwell, ruling, 6-3, that the federal subsidies found within the Affordable Care Act (ACA) are constitutional. Voting with the majority were Justices John Roberts, Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” the majority concluded. “If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

According to research by the Urban Institute, if the Court had ruled the subsidies unconstitutional, over 8 million Americans in 34 states would have become uninsured and premiums would have increased by 35%. An interactive map from the Kaiser Family Foundation also showed the possible effects of a ruling in favor of the plaintiffs.

The case came from doubt about what to make of one small phrase in the ACA: “established by the state.” Those opposed to the subsidies said this phrase meant the subsidies could only be established by the state, while those in support of the subsidies explained that it was poorly-chosen wording that should not impact any American’s insurance.

Physician organizations quickly came out in support of the ruling.

“We are thrilled and gratified by the Court’s ruling, which affirms that the citizens of all 50 states will have the opportunity to access either a state or federal exchange to obtain subsidies to purchase health insurance policies which benefits themselves, their families and loved ones,” Wayne J. Riley, MD, president of the American College of Physicians, said in a statement.

“The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis,” Steven J. Stack, MD, president of the American Medical Association, said in a statement. “The subsidies provide patients with peace of mind that they will not risk bankruptcy should they become seriously ill or injured and experience catastrophic health care costs.”

Many physicians and hospital administrators were concerned about the effects a ruling against the ACA’s subsidies. The uncertainty had also made it difficult for providers to plan for 2015 and beyond.

As the decision grew nearer and nearer, attention turned to how politicians from both parties may handle the situation if the subsidies were ruled unconstitutional. Senate Republicans were said to be considering a two-year extension of the subsidies in question, and Democrats made it known they had a plan ready if necessary.