What Does King V. Burwell Mean For New York Health Insurance?

The Supreme Court is about to rule on the Affordable Care Act’s biggest legal challenge so far. Here’s what it all means.

Update (6/26): President Obama celebrated a big political victory on Thursday when the Supreme Court ruled six to three that the Affordable Care Act’s federal tax subsidies would not be struck down. Five years after the law’s inception, the fear that millions of Americans in 34 states would lose health insurance subsidies was finally put to rest with the court’s decision.

Chief Justice John Roberts—a Republican-appointed justice—displeased many conservatives when he ruled with the majority to uphold the law in its entirety. The case, King v. Burwell, was based on an apparently ambiguous passage of five words in the Affordable Care Act, which the plaintiffs in the case argued invalidated health insurance exchanges run by the Federal Government. Roberts did not agree.

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“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” he wrote in the court’s opinion.

Justice Antonin Scalia, who was particularly frustrated with the decision—he dissented from the bench—wrote, “We should start calling this law SCOTUScare.”

But the law’s future still isn’t totally clear, either. The New York Time’s published an article immediately after the decision titled “Obamacare Ruling May Have Just Killed State-Based Exchanges;” now that it’s been decided that subsidies can be given through federal exchanges, it’s technically possible states that have already set up their own healthcare exchange, like New York, might just decide to let the feds handle the whole thing.

“There may be a little bit of buyers’ remorse going on in some state capitals right now,” Sabrina Corlette, director of the Center on Health Insurance Reforms at Georgetown University, told the Times.

Westchester Congressman Eliot L. Engel, who told Westchester Magazine that New Yorkers could count on their state-run exchange regardless of the outcome of King v. Burwell, said Friday that even if New York opted to revert to a federally run exchange, if high-quality coverage was available, it would still be a win for New Yorkers.

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“The bottom line for me is affordable health care for everybody. I don’t care if it’s done in state exchanges or federal exchanges. I don’t really care about the mechanism, what I care about is that affordable health care is available to everybody,” Engel said. “It is available to everybody in New York based on the New York exchange, and at some point if there’s a federal exchange where the quality of care is the same as it is now—or better—then it doesn’t bother me. We have to keep our eye on the prize, and the prize is that in New York everybody gets health coverage that’s affordable. I’ve always believed that health coverage is a right not a luxury.” 

Julianne Cuba wrote the update for this article

Last week, supporters of expanding Obamacare coverage in New York State celebrated a victory when legislators successfully passed a bill that allows New York’s healthcare exchange, NY State of Health, to classify pregnancy as a “qualifying life event,” making it easier for uninsured women who become pregnant to get covered by health insurance.

Despite state-level wins like this, the Affordable Care Act (ACA)—sometimes called Obamacare—remains deeply unpopular with many Americans. According to a rolling meta-poll analysis by The Huffington Post, public opinion toward the law is still a net negative, with 48.3% of respondents holding an unfavorable opinion to 43.2% who view the law favorably.

Now, five years after the law was originally passed, the ACA is facing its second real threat in the Supreme Court: King v. Burwell. For those unfamiliar with the case, King v. Burwell will decide whether the 34 states that rely on federal healthcare exchanges (because they voluntarily chose not to set up their own) are eligible for the federal tax subsidies that make mandated health insurance more affordable. According to the DC-based Brookings Institute, if the court sides in favor of the plaintiff, Virginia Vietnam War veteran David King, federal tax subsidies would be reduced by almost $30 billion—making coverage unaffordable for many.

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But what does this all mean for New Yorkers?

Since New York runs its own health exchange, New Yorkers don’t have to worry about losing their health coverage or subsidies. NY State of Health has insured more than 2 million New Yorkers as of February 2015, 88 percent of whom were previously uninsured, according to Westchester Congressman Eliot L. Engel’s office. In New York’s 16th congressional district, which Engel represents and includes areas of southern Westchester, around 74,000 people were able to sign up for insurance this past fall alone.

Westchester Congressman Eliot Engel says New Yorkers can count on their state’s healthcare exchange.

“While New Yorkers can rely on [New York’s healthcare exchange, NY State of Health], the 34 states that do not operate their own exchanges would experience significant turmoil in the event that the Supreme Court rules in favor of King. Such a ruling would strip millions of Americans of their coverage and increase the number of uninsured Americans by 8.2 million in 2016 alone,” said Engel.

In fact, if the Supreme Court rules in favor of King, it is possible some states may even use New York’s model as an example as a way to continue providing health insurance for their residents. Libertarian advocacy group FreedomWorks estimates around 16 states including Delaware, New Hampshire, and New Jersey could set up their own state-run exchanges in the event their federal subsidies are stripped away.

If the Supreme Court does rule against the ACA, the millions of Americans who will lose their insurance subsidies will still be required by law to buy coverage or face a special tax. What happens to them? Democrats’ solution would be to pass an amendment to the ACA that clarifies the short passage of ambiguous text on which the King v. Burwell case rests. Of course, Democrats hold power in neither houses of Congress.

What is the Republican plan? Well, nobody is quite sure. As NPR’s Ailsa Chang reported on Tuesday, “Republicans in both chambers have been working for months on proposals, but, so far, House Speaker John Boehner and Senate Majority Leader Mitch McConnell—and their respective caucuses—haven’t coalesced around a single path forward.”

Others, like The Huffington Post‘s Jeffrey Young, have predicted the Republicans’ path forward would be very simple: another full-bore attempt to repeal the ACA altogether. Of course, after so much time and money went into the creation of the ACA, repeal would be costly. On June 19, the Congressional Budget Office (CBO) estimated that a repeal of the ACA would add up to $353 billion to the budget deficit, and cause 19 million Americans to lose their health insurance over the next decade.

“This CBO report provides yet another reason why Republicans need to cease their constant attacks on the ACA,” Engel said. “To repeal the ACA is to revoke the health insurance of millions and sizably add to the nation’s deficit. We cannot abandon the millions of Americans who rely on the ACA for their health coverage—especially when it would cost the country billions of dollars to do so.”

Repealing the entirety of the law is seriously unlikely, since President Barack Obama would almost certainly veto any attempt to do so; a congressional veto override isn’t likely given congress’s current political composition.

A decision on the case is expected by the end of June. 

Thumbnail photo by blvdone / Fotolia

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