The Aftermath of the Supreme Court’s Affordable Care Act Ruling

In a six to three decision, the U.S. Supreme Court upheld a key component of the Patient Protection and Affordable Care Act in King v. Burwell. The majority of the court, led by Chief Justice John Roberts, determined that tax subsidies could be utilized by individuals who purchased health insurance through federally established or funded marketplaces.  This is the second PPACA case to reach the nation’s highest court, with the first National Federation of Independent Business v. Sebellius, also decided in favor of the Obama administration. With the latest Supreme Court victory, it appears that President Barack Obama’s legacy is secure for the foreseeable future. In NFIB v. Sebellius, the court upheld the individual mandate of PPACA allowing the government to penalize taxpayers who do not obtain health insurance.  Combined with the most recent decision, it seems that President Obama’s flagship legislation is relatively safe from legal attacks. In King, the court did not cede authority to the IRS to determine if tax subsidies were legal (which would have allowed future administrations leeway on how to judge such legality) but adjudicated the substance of the matter, that tax subsidies were legal in themselves.  Given the political makeup of the current court and the clear regard of the justices to preserve the health insurance coverage that millions enjoy as a result of PPACA, it seems unlikely that any future legal challenges will find a sympathetic court. This is also reinforced by the political climate.  While many Republicans have criticized the law and the health insurance exchanges, there is considerable evidence that the Right is just as pleased about the verdict in King v. Burwell as the Left. Almost 17 million Americans have acquired health insurance under PPACA (although 5.9 million did also lose their coverage), dropping the percentage of uninsured from 18 percent in 2013 to 11.4 percent in 2015.  It is likely that if the Supreme Court had ruled federal subsidies unconstitutional, almost 6 million people would have lost their coverage, and premiums for many Americans would have grown considerably. Much of the blame for this would have fallen on the opposition party, the Republicans, diminishing their standing in upcoming elections. Within the medical community, there is considerable concern about the outcome of this latest PPACA case.  Many physicians believe that the government’s misguided attempt to expand access to care can have deleterious effects on quality of care.  The added patient case load will place undue burdens upon an already overloaded healthcare system. Patients may have insurance but lack access to medical specialists when they most need them. Many also feel that granting a larger role to insurers will only increase the amount of paperwork and, ultimately, costs. Upholding the legitimacy of PPACA could have negative effects upon the U.S. healthcare system for many generations to come. For many who view PPACA as governmental overreach, the fight is not over.  Another case, Sissel v. United States Department of Health & Human Services, is already being heard by the D.C. Circuit Court of Appeals and could reach the Supreme Court. This case hinges on the constitutionality of the tax features of PPACA. According to the Constitution, all tax laws must originate in the U.S. House of Representatives, but PPACA began in the Senate.  Although the current Supreme Court has been sympathetic to the Obama administration regarding this law, it could still strike down PPACA for such a clear violation of the Constitution.

Written by:  Robert Moghim, M.D., CEO-  Moghim Medical Consulting Inc.

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