In a ruling that drew wide support from advocates of increased access to care, the U.S. Supreme Court has upheld a key component of the Patient Protection and Affordable Care Act (ACA).
In a 6-3 decision handed down June 25(www.supremecourt.gov), the court sided with the federal government in King v. Burwell, a case that questioned whether millions of individuals who purchased health insurance through an exchange run by the federal government should be able to keep their policies and premium subsidies. Justices ruled that individuals who purchase a health insurance policy through a federally facilitated exchange are eligible for premium support.
AAFP President Robert Wergin, M.D., of Milford, Neb., welcomed the court's ruling, explaining that the law achieved significant progress in improving the nation's overall health by allowing newly insured patients to see a physician for the first time in years and obtain preventive services.
"Millions of Americans now have health security because today's ruling preserves the federal subsidy for their insurance premiums," Wergin said in a prepared statement. "By ruling that federal exchange insurance plans qualify for premium subsidies, the Court has ensured that middle- and low-income families can afford the insurance that provides access to comprehensive health services."
An estimated 7.3 million Americans obtained health insurance through one of the exchanges established under the ACA since they began operating in 2014. The percentage of individuals without insurance has dropped steadily(aspe.hhs.gov) from 20 percent in 2012 to 13 percent in 2015.
About 6.4 million people would have lost subsidies worth $1.7 billion per month if the court had sided with the challengers, according to an analysis by the Kaiser Family Foundation.(kff.org) Most individuals would face monthly premiums that cost at least 250 percent more than what they pay with the subsidy. Heavily subsidized plans were essential for many people to receive necessary primary care.
"As family physicians, we saw the negative impact that lack of insurance had on patients’ ability to get the care they needed when they needed it," Wergin said. "Too often, patients without insurance would forgo or postpone needed care due to cost and then arrive in our exam room with conditions that could have been prevented or at least mitigated. By that time, they needed care that was more intensive and expensive."
At the heart of the case was a technical interpretation of eligibility requirements for premium support. The law states that subsidies will be provided for eligible individuals who obtained insurance through an exchange managed by a state. Opponents of the ACA interpreted the language literally, meaning that residents of states that chose not to establish their own exchanges and instead allowed the federal government to set them up cannot receive the subsidies.
"A successful challenge to federal subsidies for health insurance premiums would have dismantled the system's carefully designed infrastructure," Wergin said. "That framework enables insurers to cover preventive care and pre-existing conditions, eliminate annual or life-time limits on benefits, and continue a beneficiary's coverage when he or she becomes seriously ill."
Only a handful of states had announced contingency plans to preserve the subsidies had the court ruled against the federal government. Delaware opted not to create its own exchange because of its small size and the cost associated with the startup but pledged to do so, along with Pennsylvania, if the subsidies were invalidated by the Court.
Six out of 10 Americans with new insurance coverage used it to see a physician or fill a prescription, according to a survey conducted by the Commonwealth Fund.(www.commonwealthfund.org) Among respondents, 70 percent of individuals who used their insurance to obtain care said they were better off as a result.