It's anyone's guess as to whether the Affordable Care Act will survive it's latest challenge. This week, the Supreme Court heard arguments in the case of King v. Burwell.
That case centered on whether or not the law meant to provide tax subsidies to eligible people in all states, or only in states that set up their own exchange. As Solicitor General Don Verrilli argued, there are several reasons why subsidies must be available through the federal exchange as well.
For starters, it makes no sense that Congress would have purposely written a death spiral provision into the law. If tax subsidies were not available to people in some states, it's unlikely that healthy people would sign up for insurance. In those states, only sick people would sign up, and insurance companies would have to hike up premiums to cover the cost of medical care.
In order to prevent such a death spiral, states would have to set up their own exchanges, and that would create what Justice Anthony Kennedy called a “serious constitutional problem.”
By interpreting the ACA to only provide subsidies in state-run exchanges, the law would essentially require that states set up their own exchange. That requirement would be a pretty clear violation of the 10th Amendment, and so that interpretation doesn't make a whole lot of sense.
But, the Right-wing Justices have never limited themselves to what's sensible, and there is still a chance that they may influence more-moderate members of our nation's highest court.
If the Supreme Court sides with the plaintiffs, 13 million Americans in 34 states will be left scrambling to save their coverage. While some may be able to figure out how to pay premiums without the subsidies, the vast majority of people will lose the insurance coverage that they finally got.
It's not an exaggeration to say that thousands of Americans could die if our Supreme Court strikes down federal subsidies.
We probably won't know their ruling until June, so we've got to keep the pressure on Congress and force them to fix the law so that Americans can keep their much-needed healthcare.
