March 04, 2015

King vs Burwell

Learn What's Happening in the Policy Arena for CYSHCN - Read Washington DC UpdateOn March 4, the Supreme Court is hearing oral arguments in King v. Burwell, the case challenging the validity of health insurance subsidies being paid to individuals in states that did not set up their own health insurance Exchanges. The case is based on the interpretation of a four-word phrase – “established by the state” – used in a sentence stating that the premium subsidy amount is based on the cost of a “qualified health plan. . . enrolled in through an Exchange established by the State under §1311.”


The ACA had contemplated that states would establish their own Exchanges, but allowed states to use the federal Exchange should they decide not to establish their own. The challengers to the law (King and the other plaintiffs) argue that the phrase in question means that individuals in states using the federal Exchange are not entitled to premium subsidies. Secretary of HHS Burwell (represented by the Solicitor General from the Department of Justice) argues that, in the context of the whole law, the phrase is not meant to restrict subsidies in that manner since the law does not function if a substantial number of people are not able to afford insurance.


For an in-depth guide to the case, see this piece from the Kaiser Family Foundation. For a shorter analysis of the case, see “5 Things To Know About The Supreme Court Case Challenging The Health Lawfrom Kaiser Health News. See also “Five Myths about King v. Burwell,” from the Washington Post and this article from Politico Pro about what will happen if the government loses the case.


Secretary Burwell has claimed that the administration has no contingency plan if the Court should decide in favor of King, although some in Congress refuse to believe that. It is estimated that about seven million people would lose subsidies should the Court decide that subsidies are not available in states that do not run their own Exchanges.