Two Federal Courts Rule Two Different Ways on Obamacare's Subsidies
Mary Pat Whaley, FACMPE, CPC
Medical Practice Consultant, Manage My Practice LLC
Two separate federal appeals court panels ruled in essentially opposite directions on Tuesday in the ruling on challenges brought against the Federal Government. At issue is the section of the law that establishes subsidies to help lower and middle income residents purchase health insurance. The wording of the law says that subsidies may be given to those who purchase insurance through an "exchange established by the state." Although each state could establish their own exchange, if they chose not to, the federal government established one for them on healthcare.gov. At issue in the lawsuits was whether or not subsidies could be offered by through the federal exchange as well - which was the intent of the law, but didn't end up in the final wording.
It literally seems to be a drafting error, because the law could never work if so many people were not subsidized to buy the insurance. The D.C. Circuit Court of Appeals panel ruled, 2-1 that the law's literal interpretation had to be upheld - meaning no subsidies should be available through the federal exchange. Later in the day the Fourth Circuit Court of Appeals panel ruled essentially the opposite - that the law's intention was clearly for both state and federal exchanges to offer assistance.
The subsidies for middle and lower income Americans were one part of the "three-legged stool" of the law, along with the mandate to purchase minimum coverage, and the market reforms guaranteeing issuance of policies. Without any one of the three "legs", the law "falls over." Only 16 states ended up establishing their own exchanges, so the majority of Americans who purchased insurance did so through the fallback federal exchange - and would therefore be ineligible for subsidies. The case will probably next be appealed to the full D.C. Circuit Court of Appeals, but the two conflicting rulings at the federal level seem to indicate that the issue could eventually be decided at the Supreme Court. In the meantime, be ready for another round of questions from your patients, as the fate of Obamacare seems to still be hanging in the judicial balance.
Mary Pat Whaley is a Physician Advocate and Consultant who blogs atwww.managemypractice.com. Her LinkedIn group, Manage My Practice is for those interested in healthcare management.
Photo: bikeriderlondon/Shutterstock
Broadcast Media Professional
9 年here in England Uk there is the NHS people (IE)Teachers postal workers go on strike over such isues [email protected] would be able to fill you more on that and when the next strikes are likely to be (IE Firebrigade)ETC
Ambassador of Christ as a Ramp Transport Driver @ FedEx Express
10 年Just reading this column, tells me that Obamacare was never intended to WORK. Why is his system of healthcare always in court? It has not been for the people, but for special interests groups.
???? - ??? ????? - ???
10 年???? ????? ??? ????? ????? ?? ??????? ???? ????? ?????? ????
Director of Activities
10 年I do think that federal subsidies is a critical component to the Affordable Care Act. If you accept that the ACA itself is a good idea then you must agree that these subsidies are necessary. I didn't think it was the right answer for health care reform and my suspicions are proving to be correct at this point.
I HELP LEGAL TEAMS MANAGE IP ASSETS, RISK AND EFFICIENCY. All opinions are my own and not that of my employer.
10 年It is a bit odd to argue that this clause was a drafting error given the hundreds of thousands of hours and millions of dollars spent drafting, reviewing and negotiating the structure and form of the bill by thousands of intelligent, highly educated and experienced lobbyists, congressional aids and health care experts. A drafting error is when you refer to Section 3445 instead of Section 3446. That is easy to fix and the courts have created exceptions for that type of error. This seems to be a deliberate attempt to incentivize states to form their own exchanges with the stick being political retribution from the state's citizens if they are deprived of subsidies. It isn't a veto by the state of federal law, but the federal government giving the state options and incentives to participate, like in other parts of the ACA where states can opt into the Medicaid (or Medicare?).