King v. Burwell could push as many as 7.3 million Americans out of health insurance

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The Supreme Court of the United States heard oral arguments in a case that could fundamentally dismantle the provision of the Affordable Care Act that allows people to obtain private health insurance at a more affordable rate.

King v. Burwell challenges the federal subsidies given to U.S. citizens who earn a household income between 100% and 400% the federal poverty level. That means 7.3 million people who rely on the subsidy to pay for otherwise too costly premiums could lose that benefit if the plaintiffs prevail.

The ruling would apply to 36 states that are currently using the federal healthcare exchange on The 14 states that implemented their own systems would not be directly affected.

The argument hinges on a simple issue of vague wording. Under the Affordable Care Act subsidies are available in exchanges “established by the state.” Taken literally it means that only states who have their own exchanges qualify for subsidies.

But the government is hanging its defense on even fewer words, just one actually, and that is “such.” If a state doesn’t establish its own exchange, the federal government “shall establish and operate such exchange.” Basically that one word implies that, in that situation, the federal government is essentially acting for and as the state in terms of establishing a healthcare market.

The Obama administration also points out the intention of the law was to provide uniform access to subsidies for qualifying individuals. Supreme Court justices are within their rights to rule based on intention.

To expand on the possible ramifications of a ruling in favor of plaintiffs in this case, Athena Smith Ford, advocacy director for Florida CHAIN joins us by phone from Tallahassee.