Oba­macare watch­ers fret­ting over im­mi­nent pre­mium sub­sidy rul­ing

Modern Healthcare - - THE WEEK AHEAD - —Joe Carl­son

Per­haps even more than the Hobby Lobby con­tra­cep­tive cov­er­age case, Oba­macare watch­ers are biting their nails wait­ing for a rul­ing this week in a case that could de­ter­mine whether mil­lions of Amer­i­cans can keep their in­surance pre­mium sub­si­dies.

The U.S. Cir­cuit Court of Ap­peals for the District of Columbia is ex­pected to rule in Hal­big v. Burwell on whether the pre­mium tax cred­its for as many as 6.5 mil­lion Amer­i­cans in the 36 states us­ing the fed­eral in­surance ex­change are le­gal. The is­sue is whether the In­ter­nal Rev­enue Ser­vice’s rule im­ple­ment­ing the law is con­sis­tent with the law’s lan­guage that says tax cred­its to buy in­surance will be pro­vided to peo­ple who get in­surance “through an ex­change es­tab­lished by the state.”

Two fed­eral district judges have said that the law in its en­tirety makes clear that Congress in­tended the sub­si­dies for qual­i­fy­ing peo­ple in ev­ery state. But dur­ing oral ar­gu­ments in March, two judges on the three-judge ap­pel­late panel ex­pressed sup­port for the chal­lengers’ po­si­tion.

Ex­perts say the loss of sub­si­dies could un­ravel the in­di­vid­ual in­surance mar­ket in those 36 states, be­cause sicker peo­ple would find a way to keep their cov­er­age, while health­ier peo­ple would drop out.

The Hal­big case, one of four sim­i­lar chal­lenges to the law work­ing their way through the courts, is ex­pected to reach the Supreme Court, giv­ing Chief Jus­tice John Roberts a sec­ond chance to roll back the law and please con­ser­va­tives who blasted him for vot­ing to up­hold the in­di­vid­ual man­date two years ago.

Mean­while, the 4th U.S. Cir­cuit Court of Ap­peals in Rich­mond, Va., is mulling the same ques­tion in King v. Sebelius, though the three-judge panel there was seen as less friendly to the plain­tiffs’ ar­gu­ments.


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