Affordable Care Act Subsidies Upheld by Supreme Court

Court votes 6-3 in favor of upholding legislation.

The United States Supreme Court today upheld the availability of subsidies for people on the federally facilitated marketplace through the Affordable Care Act (ACA) in a significant victory for President Barack Obama’s signature legislation.

The court ruled against the plaintiffs in the King v. Burwell case with 6-3 vote in the decision written by Justice Chief Justice John Roberts. The trial focused on the interpretation of the line in the legislation that said “an Exchange established by the State.”

The argument from the plaintiffs stated that a plain reading of the legislation means subsidies should only be available to individuals who live in states that set up their own exchanges. Had the court ruled for the plaintiffs, experts predicted enrollees unable or unwilling to pay insurance premiums in whole could potentially lose coverage within 30 days.

This could have resulted in $12 billion worth of uncompensated care in 2016, raising the number of uninsured to 8.2 million people, as premiums could have increased by as much as 47%. The ruling could have been catastrophic for 34 states that use the federal marketplace or a hybrid model, with approximately 6.4 million residents who signed up for health care on a marketplace.

“The ranks of the uninsured will swell again, with all that portends in the way of untreated illness and overwhelming debt,” the American Hospital Association said in a press release.

Those who supported maintaining the subsidies intact, including a bipartisan group of legislators who drafted the legislation, claimed the phrasing of “an Exchange established by the State” was a drafting error. Former Republican Senator Olympia J. Snowe of Maine told The New York Times that there was never any distinction made regarding subsidies between federal and state exchanges.

National Community Pharmacists Association CEO B. Douglas Hoey, RPh, MBA, said the ruling will aid pharmacists in helping to guide patients to optimal outcomes.

“Community pharmacists are critical front-line providers of care to many Americans, particularly those in underserved rural and inner-city areas," he said. "Every day they help patients, with or without insurance, obtain the prescription drugs or other care that they need. While the political debate over US health care will continue, today’s ruling provides a degree of clarity for community pharmacists as they continue to help patients navigate a complicated health care system.”