The Supreme Court decision to affirm the legality of subsidies available to consumers in all states to assist in purchasing health insurance under the Affordable Care Act ensures that important consumer protections and health information technology policies remain in force under the law.
Had subsidies in part or in whole been taken away, much of Obamacare could have unraveled.
Now, health insurance exchanges and subsidies available to qualifying consumers stay, as do many programs for consumers that better level the playing field with insurers, expand access to healthcare and strengthen families. These include:
* Expansion of community care centers in medically underserved regions
* Limitis on the administrative costs of insurers
* Support for accountable care organizations with coordinated population health management programs
* Coverage for persons with pre-existing medical conditions
* A restriction on lifetime coverage limits
* Coverage on parental policies for adult children up to age 26
* Lower prescription drug costs for many persons, particularly those on Medicare.
The HIT policies that remain in force under the ACA include:
* Statewide health insurance exchanges
* Operating rules to make HIPAA electronic claims and related transactions more standardized
* New HIPAA transactions for electronic fund transfers, remittance advice and claims attachments
* Expansion of data analytics fueled with the availability of Medicare claims data
* A health plan identifier
* Electronic enrollment in health and human services programs
* A new tax on medical devices including those collecting and/or transmitting data.
The Supreme Courts ruling was consistent in affirming the constitutionality of tax subsidies for all eligible individuals buying health insurance under Obamacare, regardless of state residence.
Opponents had a good argument that a tiny phrase in the Affordable Care Act limited subsidies only to states that implemented their own exchange. Taken literally, the phrase did just that. But four liberal and two conservative justices did not take the phrase literally, arguing the role of the court is to say what the law is, not just a phrase in a law.
That is easier in some cases than others, the majority opinion acknowledges. But in every case, we must respect the role of the Legislature and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan.
And to the majority of justices, the plan was clear. Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B (pertaining to subsidies) can fairly be read consistent with what we see as Congresss plan, and that is the reading we adopt.
In a dissenting opinion, Justices Scalia, Thomas and Alito embraced a literal interpretation of the disputed half-sentence in the huge law. The Court holds that when the Patient Protection and Affordable Care Act says Exchange established by the State, it means Exchange established by the State or the Federal Government. That is, of course, quite absurd, and the Courts 21 pages of explanation make it no less so.
To the three justices, there are two types of exchanges--those established by a state, and those established in a state by the Secretary of Health and Human Services because the state refused to do so. Thats not what the law says, they argue. The Secretary of Health and Human Services is not a State. So an Exchange established by the Secretary of Health and Human Services is not an exchange established by the Statewhich means people who buy health insurance through such an Exchange get no money under Section 36B.
While the Supreme Court decision means the ACA remains as is, more legislative fights could follow. Some congressional Republicans, despite now badly losing two Supreme Court opinions on the law, vowed again to repeal Obamacare. Thats impossible with President Obama and his veto pen still in office, and they know it. But GOP lawmakers make clear they will continue attempts to make changes to the law.
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