Question

Constitutional Issues in Healthcare: Do you agree with the court ruling for KING ET AL. v. BURWELL, SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL. Was this a fair constitutional ruling for corporation vs employees.

Answer 1

I don’t agree with the court ruling for KING ET AL. v. BURWELL, secretary of health and human Services, ET AL.

King v Burwell is a court case set to be considered by the Supreme Court over who is eligible to receive the health insurance subsidies contained in the Affordable Care Act (ACA)

ACA relies on two major provisions to increase insurance coverage:

• An individual mandate requiring most people to get health insurance coverage or else pay a penalty.
• A system of subsidies intended to make health insurance coverage affordable, including health exchanges where those without Medicaid or access to affordable employer-sponsored health insurance can purchase subsidized health insurance.

The ACA allows states to set up their own health insurance exchange or participate in the federally run exchange. The plaintiffs (King) argue that, because the legislation refers to those enrolled “through an Exchange established by the State,” individuals in states with federally run exchanges are not eligible for subsidies. However, many analysts argue that the clear intent of the legislation is to allow individuals to obtain subsidized insurance regardless of whether they obtain it through a state exchange or the federal exchange. Currently, 34 states rely on the federal exchange and could lose subsidies if the Supreme Court rules in favour of King.

Researchers at the Urban Institute estimate that a Supreme Court ruling in favour of King would reduce federal tax subsidies by $29 billion in 2016, making coverage unaffordable for many and increasing the ranks of the uninsured by 8.2 million people. Furthermore, because healthy, low-cost individuals would disproportionately leave the marketplace, insurance premiums for those remaining would have to increase by an average of 35 percent (and premiums would now be unsubsidized, resulting in much larger increases in costs for most people.)

It is also likely that many insurance companies would cease participating in the federal exchanges, given the loss of potential customers and the deterioration in the health status of their customer base. It is possible that a “death spiral” would occur: as premiums rise, the healthiest customers leave the marketplace, causing premiums to rise more, causing more healthy people to leave, etc.

A ruling in favour of King is not beneficial for any states. In contrast to the ACA’s Medicaid expansion where states will eventually be responsible for 10% of the cost and some states worry their share could be increased in the future exchange subsidies are fully funded by the federal government. The subsidies result in more money flowing into the states, while placing no direct strain on state budgets.

Was this a fair constitutional ruling for corporation vs employees?

No, this is not a fair constitutional ruling, since it would have little to no effect on employer-provided health insurance.