This week, the Supreme Court heard oral arguments in the Affordable Care Act case of King v. Burwell. The case involves a challenge to providing premium tax credits to consumers who receive Affordable Care Act insurance coverage in states using Federally Facilitated Marketplaces.
An adverse ruling would strip millions of Americans of health coverage, throw insurance markets into turmoil, and have widespread ripple effects.
Never before have I seen my colleagues fight so hard against tax credits. These truly are strange times we live in. Let’s talk about what is truly at stake here.
Over the past three months, consumers in Missouri sent a clear message: The Affordable Care Act is working, and the quality health coverage offered through the Health Insurance Marketplace is an affordable product that consumers want.
The Affordable Care Act isn’t perfect. No law is, to tell you the truth. But it is working. There is simply no legal basis for taking away health coverage from millions of Americans. Period. Thanks to the ACA, more than 11.4 million people have signed up for coverage through the exchanges, including 8.6 million through the federally-facilitated marketplaces. The uninsured rate has fallen to record low.
The law is clear. The text, history, and purpose make clear that premium tax credits should be available to anyone eligible, whether they live in a state with its own marketplace or one with a federal marketplace.
The ACA is making a big difference, in Missouri and around the country:
80 percent of Missouri Marketplace enrollees as of December 2014 could have obtained coverage for $100 or less after any applicable tax credits in 2015.
In Missouri, consumers could choose from 7 issuers in the Marketplace in 2015 – up from 4 in 2014.
Missouri consumers could choose from an average of 20 health plans in their county for 2015 coverage – up from 17 in 2014.
At the end of Open Enrollment, 253,969 Missouri consumers had selected a plan or were automatically re-enrolled in Marketplace coverage.
88 percent of Missouri consumers who were signed up as of January 30 qualify for anaverage tax credit of $284 per month through the Marketplace.
Maybe you are not persuaded. Let me share with you what could happen if the challenge to the law prevails.
A decision for the challengers will unleash chaos and would be disastrous for millions of people. Studies estimate that anywhere from 8 to 10 million Americans would lose their health insurance if the Supreme Court takes away the tax credits they need to afford coverage. An additional 5 million children, through no fault of their own, could also lose coverage.
Even if you don’t have insurance through the Affordable Care Act, a decision for the challengers would put insurance markets across the country at risk of collapse. Insurers have warned the Supreme Court that taking away the tax credits, "would create severely dysfunctional insurance markets" in nearly three dozen states. “It would leave consumers in those States with a more unstable market and far higher costs than if the ACA had not been enacted,” the health insurers’ brief states.
Everyone will be impacted by the chaos and disruption to the health care system. The ACA is deeply embedded in nearly every element of the American health care system. Suddenly eliminating the heart of the law will cause substantial disruptions and damage to hospitals, insurers, and other providers. The hospital industry has warned of "a widespread and massive disruption … to the entire health care system nationwide."
We've achieved an historic reduction in the uninsured – the largest over any period since the early 1970s. In 2014, hospitals saved an estimated $5.7 billion in uncompensated care costs because of the Affordable Care Act, with states that have expanded Medicaid seeing about 74 percent of the total savings nationally, compared to states that have not expanded Medicaid.
For these reasons, I am confident that the Supreme Court will issue the only ruling consistent with the text, structure and history of the law: Federal tax credits are available to every eligible individual in the nation.