Two questions will dictate not only the future of healthcare, but also the balance of power between Washington, D.C., and the states, and the separation of powers between the federal branches. One concerns state sovereignty, the other the heckler’s veto.
When justices heard arguments regarding the Affordable Care Act (ACA, or Obamacare) in King v. Burwell on March 4, Justice Anthony Kennedy and Chief Justice John Roberts suggested ways they might vote to uphold an Internal Revenue Service rule granting taxpayer subsidies to Obamacare exchange policies in states that refused to join that part of the ACA.
The ACA’s Section 1401 provides that subsidies are granted for insurance policies purchased on exchanges “established by the State under (Section) 1311.” By contrast, the federal exchange is created by Section 1321. Challengers argue this was deliberate, pressuring states to create exchanges and join Obamacare, like the provision threatening states with canceling all Medicaid funds if they did not join the ACA’s expanded Medicaid. (The court struck down that part of the ACA in 2012 for coercing the states, violating the 10th Amendment.) The now-infamous videos of Dr. Jonathan Gruber corroborate this theory.
Americans’ tax burden is already $3 billion heavier because of Ohio Gov. John Kasich’s expansion of Medicaid under Obamacare.
By putting more able-bodied, working-age childless adults on Medicaid than Kasich projected, Obamacare expansion is reducing incentives to work and threatening traditional Medicaid recipients’ access to care faster and at greater cost than anticipated.
After Kasich expanded Medicaid unilaterally, a state panel approved $2.56 billion in Obamacare spending for the expansion’s first 18 months. The money was meant to last until July, but it ran out in February.
Kasich’s Obamacare expansion cost $323 million in March — 84 percent greater than estimates revised just six months earlier.
Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act.
Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer-call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are weighing turning over part or all of their troubled marketplaces to the federal exchange, HealthCare.gov, which is now working smoothly.
On March 4, 2015, the Supreme Court heard oral arguments in King v. Burwell, a case that could have a significant impact on our healthcare system and on millions of Americans. A decision is expected in June 2015. To start this conversation, take the quiz to see what you know about what’s at stake in the King v. Burwell case