D.C. Court: No Subsidies For 7 Million ACA Enrollees

By  //  July 22, 2014

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RULING SAYS OBAMACARE ALLOWS PREMIUM SUBSIDIES ONLY THROUGH STATE EXCHANGES

EDITOR’S NOTE: This breaking news from the Washington D.C. Circuit Court of Appeals could be a major legal blow to the Affordable Care Act (ACA, aka Obamacare). The Court’s ruling is based on specific language of the legislation referring to premium subsidies allotted only through purchase of  ACA health insurance on the state exchanges and not the federal exchanges, through which almost 7 million Americans were enrolled.

— Dr. Jim Palermo, Editor-in-Chief

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A federal court on Tuesday struck down a rule from the Internal Revenue Service making Americans in federally run health insurance marketplaces eligible for subsidies, a decision that puts 7 million ACA enrollees in jeopardy of losing premium subsidies and could seriously imperil implementation of the Affordable Care Act.

KAISER HEALTH NEWS – -A three-judge panel at the U.S. Appeals Court for the D.C. Circuit threw the fate of an important part of the Affordable Care Act into doubt Tuesday.

In a 2-1 decision in Halbig v. Burwell, the judges ruled that the Internal Revenue Service lacked the authority to allow subsidies to be provided in exchanges not run by the states. That could put at immediate risk the millions of people who bought insurance in the 36 states where these online insurance marketplaces are run by the federal government.

“Because we conclude that the ACA unambiguously restricts the section 36B subsidy to insurance purchased on the Exchanges ‘established by the state,’ we reverse the district court and vacate the IRS’s regulation,” said the decision by Judge Thomas Griffith.

U.S. Court of Appeals building in Washington (Photo by AgnosticPreachersKid via Wikimedia Commons)

U.S. Court of Appeals building in Washington (Photo by AgnosticPreachersKid via Wikimedia Commons)

Meanwhile, just an hour later, another three-judge panel on the 4th Circuit Court of Appeals in Richmond, Va., came to the opposite conclusion – upholding the federal subsidies.

“It is therefore clear that widely available tax credits are essential to fulfilling the Act’s primary goals and that Congress was aware of their importance when drafting the bill,” said the decision written by Judge Roger Gregory.

The Obama administration said it will appeal the Halbig decision. The Justice Department will ask the entire appeals court panel to review the decision, and that panel is dominated by judges appointed by Democrats, 7-4. The issue is also in other courts around the country.

White House spokesman Josh Earnest said: “There’s a lot of high-minded case law that’s applied here. There’s also an element of common sense that should be applied as well, which is that you don’t need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health care costs, regardless of whether it was state officials or federal officials who were running the marketplace.”

‘’We believe that this decision is incorrect, inconsistent with Congressional intent, different from previous rulings, and at odds with the goal of the law: to make health care affordable no matter where people live.  The government will therefore immediately seek further review of the court’s decision,” said a statement from the Justice Department.

The actual text of the law says the sliding-scale tax credits are only available for coverage purchased “though an exchange established by the state,” which the Court interprets as excluding policies purchased on the 34 federally run insurance exchanges.

The actual text of the law says the sliding-scale tax credits are only available for coverage purchased “though an exchange established by the state,” which the Court interprets as excluding policies purchased on the 34 federally run insurance exchanges.

Meanwhile, Elizabeth Wydra, chief counsel for the Constitutional Accountability Center said the ruling wouldn’t take effect right away. “The court’s rules are that it doesn’t happen for 45 days,” to give the government time to ask for a full en banc hearing, “or 7 days after the en banc hearing has been denied.”

Should the decision eventually stand, however, it could mean at least five million Americans would face an average premium increase of 76 percent, according to a projection done by the consulting firm Avalere Health.

The court said that the wording of the health law “plainly makes subsidies available only on Exchanges established by states,” and that the legislative history of the bill “provides little indication one way or the other of congressional intent.”

But Judge Harry T. Edwards offered a strong dissent. “It makes little sense to think that Congress would have imposed so substantial a condition in such an oblique and circuitous manner.”

The case could end up in the Supreme Court.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.


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