Just When You Thought It Was Safe…

Almost as soon as it appeared that the Affordable Care Act had been accepted as a legitimate part of government services, along comes the political equivalent of Bruce in the movie Jaws.

It’s a case before the U.S. Supreme Court called King vs. Burwell, challenging the legality of tax credits offered through the federal health insurance exchange, HealthCare.gov.

The five conservative Justices of the Supreme Court will control the fate of Obamacare. If their ruling eliminates tax credits offered through HealthCare.gov, enrollees in 34 states without state exchanges could lose the tax credits that makes their health insurance affordable.

Recently, three academics published a piece in the New England Journal of Medicine that outlined the challenges to the ACA in a “worst case” Supreme Court scenario.

They suggested that the most likely attempt at a solution would be restoring the tax credits by converting the federal exchange into state exchanges.  Sadly, the authors conclude that it would be difficult for the Obama administration to accomplish this.

They talk about three problems. One is legal because the law sets specific requirements for state exchanges. Another is practical because states might not have time to act after a court decision in June. And the third is political because Republicans are unlikely to help fix Obamacare, a program they’ve tried repeatedly to repeal.

Nicholas Bagley, a University of Michigan law professor who co-authored the NEJM article, has said the more he looks at the situation that could cost millions their health insurance, "the more alarmed I've grown."


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