By S. E. Williams, Staff Writer
Last week for the second time since its historic passage in 2010, the United States Supreme Court rebuffed right-winged attempts to derail President Barack Obama’s signature legislative achievement, the Affordable Care Act.
Since 2010, conservatives have left no stone unturned in their relentless quest to destroy the health care legislation. Republican congressional representatives have held at least 50 votes in unwavering attempts to weaken/obliterate it; Republican governors largely refused to establish state exchanges or accept medical subsidies in attempts to undermine its viability; Republicans lost a presidential election that largely hinged on it; and, around the country lawsuits aimed at obstructing the legislation abounded.
In the final analysis, what was intended to kill the Affordable Care Act by a “thousand cuts” appeared to actually strengthen and reinforce its legislative intent—to expand access to health insurance, to protect patients against arbitrary actions by insurance companies, and to reduce health care costs.
As a matter of fact, court observers believe not only did this most recent Supreme Court foray against the Affordable Care Act fail to gut the bill it may have closed the door on future conservative attempts to eliminate the bill’s subsidies. The Supreme Court reached a 6-3 decision last week in the King v. Burwell ruling that reinforced and upheld this key element of the legislation.
The entire case hinged on the judicial interpretation of a few significant words “an Exchange established by the State” which, when read out of context seemed to suggest the tax credits offered under the auspices of the Affordable Care Act (ACA) were only available in the handful of states that established their own exchanges. However, when considered in context it was clearly apparent to the majority of the court that an obvious staff error should not be the standard used to make judgments about the intent of the complete, complex legislation.
When the words were considered in context it was clear to the court that Congress intended the (tax credit) subsidies be applied to all ACA enrollees as appropriate, regardless of whether they subscribed through a state or federal exchange.
It was this interpretation that informed the Supreme Court decision. However, the decision went further than the obvious. The bill’s intent on the issue of subsidies was that tax credits be available in all 50 states. Because this determination is an actual part of the legislation and was not left to the discretion of the Internal Revenue Service as clarified in the Supreme Court ruling, future United States presidents will have no authority to eliminate these credits by Executive Order.
The Affordable Care Act is an interdependent organism based on three major reforms. Firstly, the guaranteed issue and community rating requirements intended to ensure that everyone who wishes to can in fact buy health insurance. Secondly, the Affordable Care Act includes a requirement that individuals maintain health insurance coverage or make a payment to the IRS. This effort is designed to provide an incentive for people to buy insurance before they get sick. And thirdly, the tax credits for individuals with household incomes between 100 and 400 percent of the federal poverty level. This necessary component of the law was intentionally designed to make insurance more affordable.
In states like California, that established their own healthcare exchanges (i.e., Covered California), the components of the law as detailed above have worked in synch with one another to expand healthcare coverage—the same is true for subscriptions through the federal exchange.
The court’s ruling is an expansive victory for the Obama administration and his legacy. However, despite the concise clarity of the court’s majority ruling conservatives have vowed to fight on against the legislation–however, the ruling may have removed much of the fuel needed to fan the flames of continued discontent.
As health care coverage under the Affordable Care Act continues to expand and more and more citizens understand the full extent of its benefits, critics expect the vociferous resistance initially raised against the law will continue to dissipate.
According to the US Census Bureau, in 2009 before the ACA was implemented, about 48.6 million or 15.7 percent of America’s population was uninsured. Since its implementation the uninsured rate has declined across all race/ethnicity categories. There was a greater decline among African Americans and Latinos than among Whites. According to Gallup, among Whites, the uninsured rate declined by 5.3 percentage points against a baseline uninsured rate of 14.3 percent, resulting in 6.6 million adults gaining coverage; among African Americans, the uninsured rate declined by 9.2 percentage points against a baseline uninsured rate of 22.4 percent, resulting in 2.3 million adults gaining coverage; and, among Latinos, the uninsured rate dropped by 12.3 percentage points against a baseline uninsured rate of 41.8 percent, resulting in 4.2 million adults gaining coverage. The baseline period included 1st Quarter 2012 through the 3rd Quarter 2013.
Despite the avowed interest of conservatives to continue the fight against ACA, Judge Roberts in last week’s majority opinion made it clear the U.S. Supreme Court in not the place to seek resolution on this issue. “In a democracy,” he said, “the power to make the law rests with those chosen by the people.”