Threat to affordable care

In March, the Supreme Court heard oral arguments in King v. Burwell, a suit devised by the Competitive Enterprise Institute to cripple a core provision of the Affordable Care Act: the federal subsidies for Americans buying coverage on the federal exchange.

The plaintiffs’ case is built on the fact that a phrase in the 2010 law can be interpreted as authorizing these subsidies only for people in the 14 states that have set up their own exchanges. They argue that Congress intended to make an incentive for states to create exchanges—and that the Obama administration is violating the law by instead making subsidies available in all states.

The administration counters that the law’s provisions clearly apply to state and federal exchanges alike. Indeed, there is little evidence that the bill’s drafters intended otherwise. When Steven Brill was writing his book on the ACA (see review in this issue), none of the congressional members and staffers he interviewed mentioned that the subsidies might apply only to the state exchanges. Brill noted recently that Senator Charles Grassley—the Iowa Republican who worked on the law but ultimately voted against it—“seemed incredulous” at the very suggestion.