This past week, House Republicans voted for the 56th time to take healthcare away from 10 million Americans. To be sure, that vote was mere theatre to humor the Republican base because even if or when it gets through the McConnell Senate, President Obama will veto the bill.
However, the Republicans aren’t limiting their war with the health and lives of millions of Americans to political theater. Next month, the Supreme Court of the United States will consider King v. Burwell, in which millions of people will be affected. The Court will consider if the ACA originally intended to restrict subsidies to people in states that set up their own exchanges. This is the third time the Supreme Court is considering a case in which the goal was to take healthcare away from millions of Americans.
When it comes to providing access to affordable healthcare, even with the Affordable Care Act, America lags behind other nations. No doubt, the ACA is a vast improvement over corporate death panels, the blackballing of people with pre-existing conditions and the inherent sexism in which women were charged higher premiums simply because we are women.
Ultimately, the Affordable Care Act is the health care system that Republicans loved before it became the compromise that President Barack Obama accepted as an alternative to doing nothing.
Since then Republicans compared the ACA to slavery and the Holocaust, while offering nothing that addresses the fact that corporate death and sick care is not healthcare. The irony is for profit healthcare does the very things Republicans try to attribute to the ACA.
Should King prevail in the Supreme Court, people who live in states that didn’t set up their own exchanges will cease to be eligible for Federal subsidies. In turn that will drive up insurance costs for people in states with exchanges, and therefore make healthcare security a thing of the past for them.
Healthcare insecurity means people put off going to the doctor until whatever ails them becomes unbearable, potentially deadly and without question more expensive to treat. It means a return to the days of the clinic of last resort – the emergency room where healthcare is also the most expensive.)
The plaintiff in this case, is 64 year old David M. King, who, with an income of $39,000, cannot afford the market based healthcare his party believes in. In her profile of King, Jennifer Haberkorn of Politico said:
A review of King’s public social media accounts show he is a proud grandfather who loves his family, enjoys cooking and sharing photos from conservative blogs. One image shows a photo from the movie “Back to the Future” with instructions to the time traveler: “Marty, there is no time to lose. You must go back in time and give Obama’s dad a condom.
Obviously, King has little to gain accept “freedom” from access to healthcare. However, King personifies the very thing that is wrong with that system. Not only is he financially precluded from buying “market based” healthcare, it is highly probable that the rest of us will end up picking up the tab for his healthcare expenses.
He argues that this is about his freedom of choice and getting away from the “tyranny” of government subsidies that would make healthcare accessible to him and would entail that he pay something based on his ability to pay. He’s wrong.
This is about what his suit does to the 13 million Americans who want healthcare security but were denied the freedom to make that choice under the old system, be it because they couldn’t afford it or because they had pre-existing conditions.
Not that King’s motive will or should matter to the Supreme Court. However, even if one wants to be charitable to his contention that the ACA only allows federal subsidies to people in state based exchanges, it doesn’t work.
The text that King relies on to make his case is 26 U.S.C. § 36B(c)(2)(A)(i) which says:
the monthly premiums for such month for 1 or more qualified health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section152) of the taxpayer and which were enrolled in through an Exchange established by the State under 1311  of the Patient Protection and Affordable Care Act,
The IRS interpreted that to mean that people who get healthcare through state exchanges or the federal exchange and are eligible for subsidies can get them. King (and his friends) hinge their argument on a “plain reading” of the law. Even then, King’s argument doesn’t work.
For one thing, King (and his supporters) claim that a letter by Democrats proves King’s claim regarding the original intent of the ACA. However, even the most literal interpretation of that letter suggests that King (and his backers) are grasping at straws.
You can read the letter in its entirety and judge for yourself at the link above if you wish. In my reading, the letter, actually suggests an intent to assure that people living in obstructionist states can still benefit from what is, in reality, a national program – including eligibility for subsidies.
It begins with recognizing that some states will refuse to set up state exchanges and goes on to the ways that can be addressed. Eventually it gets to the point of discussing a federal exchange and that exchange’s ability to administer “federal affordability credits.”
Reforming our nation’s health care system is a national effort that requires a national solution, not a piecemeal approach. A single, national health insurance exchange will not only administer federal affordability credits and receive federal start-up funds, but will also be charged with enforcing federal laws and regulations. As the Commonwealth Fund recently reported, a single, national health insurance exchange would ensure uniform, national availability of health insurance plans, better serve consumers, and have the resources to appropriately regulate insurers.
Think Progress asked the letter’s author, Rep. Lloyd Doggett (D-Tx) via email what he and his cosigners meant in the letter. Here is what he is reported to have said:
Doggett replied that he and his ten colleagues “neither specifically mention nor contemplate the far-fetched argument now advanced by reform opponents that premium tax credits would only be available for state-based exchanges.”
As important, elsewhere in the law The Department of Health and Human Services is ordered to set up an exchange in states that fail to set up their own. So, in reality, the Federal exchange acts as a proxy to fulfill the same intentions of the law as occurs in states that set up their own exchange. In that sense, there was an inferred intent, explicitedly confirmed by the letter, that people would have the same benefit of the law, regardless of whether they signed up for Obamacare via a State exchange or the Federal Exchange.
King’s argument is both far fetched and desperate. The question is whether the Supreme Court will rule based on the stated intentions of lawmakers or someone whose lawsuit could take healthcare away from 13 million Americans because the plaintiff in that suit wishes Obama was never born.
Image: The Kaiser Foundation