The U.S. Supreme Court’s rejection of the latest legal challenge to the Affordable Care Act preserves federal tax subsidies that nearly 270,000 consumers in Kansas and Missouri used to help them purchase health insurance.
If the decision handed down Thursday had gone the other way, those consumers, many of whom were previously uninsured, might have been forced to drop their coverage.
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At issue was whether consumers in Kansas, Missouri and at least 32 other states were eligible for tax credits that reduce the cost of their premiums. The court rejected a claim made by ACA opponents that competing language in the law meant that Congress intended to limit those subsidies to consumers in states that created their own marketplaces.
The 6-3 decision, written by Chief Justice John Roberts, was hailed by ACA supporters and criticized by those still seeking to repeal the law, including members of the Kansas and Missouri congressional delegations.
U.S. Sen. Pat Roberts, a Kansas Republican, said the decision “does not take away from the fact that Obamacare is fundamentally broken.”
Roberts’ Republican counterpart from Missouri, U.S. Sen. Roy Blunt said he was he was disappointed that the court didn’t accept the clear language of the law.
“I’ll keep fighting to protect Missourians from the president’s flawed health care plan and replace it with a patient-centered system that lowers costs, increases choices and providers greater access to quality care,” Blunt said.
First District Kansas Congressman Tim Huelskamp, using the same playbook, echoed Blunt’s call for Congress to pass a “patient-centered replacement” for the ACA.
Missouri Congressman Emanuel Cleaver, a Democrat, had a different take. Cleaver said the decision will save lives.
“Today’s decision protects 6.4 million Americans across the country and 200,000 in Missouri from suffering,” Cleaver said. “It is a victory for us all.”
Former Kansas Insurance Commissioner Sandy Praeger, also a Republican but a supporter of the law, also praised the ruling.
“It was the correct decision,” said Praeger, who represented the National Association of Insurance Commissioners when Congress was debating the ACA.
If the court had ruled the tax credits illegal in Kansas, Missouri and the other contested states, “It would have caused chaos in the marketplace,” Praeger said.
Without the subsidies, Praeger said, more than 80 percent of the 85,490 Kansans who have purchased health insurance in the ACA marketplace may have been forced to drop their coverage.
The potential impact would have been even greater in Missouri, where nearly 90 percent of the 219,953 people who purchased ACA plans used the tax credits to lower the cost of their premiums.
Current Kansas Insurance Commissioner Ken Selzer issued a guarded statement that said his office would “continue working to find ways to make consumer health insurance affordable for Kansans.”
The challenge to the health reform law hinged on whether Congress intended to restrict subsidies to states that established their own marketplaces as a way of encouraging states to do so rather than to rely on the www.healthcare.gov website operated by the U.S. Department of Health and Human Services.
But Linda Sheppard, the former director of health care policy and analysis at the Kansas Insurance Department, said if that was the intent it was never mentioned in the series of implementation meetings she participated in with federal officals.
“From my personal experience, there was no evidence of that,” said Sheppard, who is now a senior analyst at the Kansas Health Institute in Topeka.
In 2011, Kansas was moving toward creating its own marketplace, then more commonly referred to as an exchange. But Republican Gov. Sam Brownback halted those efforts and returned a $31.5 million federal grantthat Praeger had obtained to help pay for the exchange.
Missouri Gov. Jay Nixon, a Democrat, said in addition to preserving the subsidies for needy consumers, the ruling could help clear the way for Medicaid expansion because it removes doubt about the future of the ACA.
“For the second time in a row, this law has been upheld,” Nixon said. “Whether you like it or not, it’s there. So, the real question on the ground is whether or not we’re going to continue to send $2 billion a year of Missouri’s hard-earned tax dollars to other states for them to expand health care or whether we’re going to use it in Missouri.”
The Republican-led Legislature, however, remains adamantly opposed to Medicaid expansion, describing it as a non-starter.
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
