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For 1 Million Floridians, Health Insurance Again in the Balance as Supreme Court Rethinks Subsidies

| November 10, 2014

Hanging by a thread. Again. (Amanda Oliveira)

Hanging by a thread. Again. (Amanda Oliveira)

Close to 1 million Floridians have enrolled in the Affordable Care Act better known as Obamacare, in the state which had the second-highest rate of uninsured Americans after Texas.

The average subsidy for Florida’s beneficiaries of the Affordable Care Act is $3,000 apiece.

Enrollment and subsidies are now at risk, because once again, the Supreme Court will decide whether the Affordable Care Act lives or dies.

Defying expectations, the court announced Friday it has agreed to hear – during this term – a case that challenges the heart of the law: subsidies to help people pay their insurance premiums. In about three dozen states, the federal government runs the online marketplaces where individuals can find health plans.

At issue is a phrase in the law stipulating that subsidies to help those with incomes under 400 percent of poverty are available only in “exchanges established by a state.” The authors of the law argue that the rest of the statute makes it clear that subsidies are available not only in state-run exchanges, but in those where the federal government is doing the work of the state.

When the law was written, most people–and lawmakers–expected that states would want to run their own exchanges. It was a surprise when most opted to let the federal government do it instead. Florida was among those states as Gov. Rick Scott and a hostile Legislature opposed developing an exchange in the state.

A decision to strike down the subsidies in federally-run exchange states could end up making insurance unaffordable for millions of people and threaten the viability of the law’s entire health insurance program.

If the law is crippled by the elimination of subsidies in states like Florida, the rest of the Affordable Care Act could become untenable, and with it such provisions as the prohibition on insurers to exclude people with pre-existing conditions, or the prohibition on lifetime benefits caps, or the requirement that health plans provide a minimum standard of coverage.

In a rare Friday afternoon notice following their closed-door conference, the justices noted with no further comment that they have agreed to hear King v. Burwell. That is the case in which a three-judge Appeals Court panel in Richmond ruled unanimously that Congress did intend to allow subsidies to be available nationwide.

That same day, a panel in the District of Columbia Court of Appeals ruled 2-1 the opposite way. But that case, Halbig v. Burwell, was vacated when the full court agreed to rehear the case. That is scheduled for December. Because there are not yet contradictory decisions by appeals courts, most observers thought the Supreme Court would at least wait until the lower courts were finished considering the case before weighing in.

“We are disappointed that at least four Justices decided to hear this case despite the lack of a circuit split and while this issue is still being actively litigated in the lower courts,” said Doug Kendall of the Constitutional Accountability Center, which is representing the members of Congress who wrote the law. “But we remain very confident that the Court will ultimately find that both the text of the ACA and the intentions of Congress mandate a ruling for the federal government.”

–FlaglerLive and Kaiser Health News

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8 Responses for “For 1 Million Floridians, Health Insurance Again in the Balance as Supreme Court Rethinks Subsidies”

  1. Charles Ericksen Jr says:

    Let’s also not forget, what will happen when those who declared their estimated earnings for 2014, to determine the original subsidy, submit their IRS forms for 2014. If your estimated earnings were right on, there should be no problem. BUT, if your estimate earnings were lower than your actual earnings, you will/could be be in for a surprise. IRS will, then determine the actual higher rate you should have paid, and deduct any additional money you now owe, prior to sending any refund you expected. If the difference is greater than your requested refund, you will be expected to pay it. Bottom line if you received a subsidy , be prepared for a long wait on a refund.

  2. KB63 says:

    I don’t know why they have to rethink the subsidies. Two different insurance companies are raising the rates for 2015 – mine 22%, my co-worker 35%! They didn’t make enough money the first year so the rates are skyrocketing now. We don’t qualify for subsidies so they should just take a chunk of our outrageous prices to help out! They need to stop this insurance madness.

  3. Fred says:

    All you have to do is call it a “Tax Refund” not a “subsidy” and it will get by this court. The “stupidity of the American voter” let this sham of a program get passed and now we are stuck with it.

  4. rickg says:

    Ah yes… SCOTUS the last bastion of RWNJs line of defense.

  5. Obama 2014 says:

    Amazing how many millions of dollars has been spent to try and kill a law that helps low income american veterans and republican voters. Damn liberals and their affordable health care, glad they voted for Rick Scott!

  6. Groot says:

    The health care system needed reformed. Some aspects of the ACA are valuable and equitable. The preexisting conditions part of the legislation was long over due. I would like to have seen it go further and decide what health care costs. It’s such an abstract and subjective think now, the value of health care. It all depends on what your insurance has worked out in the way of a contract with the providers. Everyone should have insurance because if you don’t, you will pay the uncontracted off the street rate which is astronomical. If you don’t pay, then later your unpaid bad debt gets worked into the rates and we all pay more. However, requiring everyone to have insurance is not practical and the subsidies are not equitable. Medicaid should have been expanded to include more people and count income as well as assets for expanded eligibility and prosecute Medicaid fraud. They do not do understated eligibility fraud referrals in Florida for private individual Medicaid cheats. The ACA needs reworked and 86 those subsidies.

  7. Anonymous says:

    According to the AHCA, Insurance companies are not allowed to hold policy-holders to terms of their own choosing for extended periods of time, also of their own choosing. The Insurance industry has turned this around to their advantage by offering new policies but on a month-to-month basis, thereby seemingly acting in accordance with the new law. But they are violating the spirit of the new law by raising rates whenever they choose to do so, on the flimsiest pretexts…which they can now do with subscriber’s now being tied to month-to-month term limits on their policies. In other words, they are exploiting any loophole they can take advantage of under the new law to rake in even more profits which they whine about need to “offset costs.” I hope that the States that have Insurance Commissioners (that have not been completely elminated/defanged by Republican governors and lawmakers) will be vigilant and make the major insurance companies who are doing these things, such as BC/BS, return the monies that are not actually being used in paying consumer costs BACK to the consumers, in the form of rebates and refunds. The problem is not with the intent or purpose of the AHCA. The problem lies in the greed and entitlement of the Insurance industries, Big Pharma, and many parts of our medical system which have signed on enthusiastically for a business model that has been running amok for a long time–at great human cost. These loopholes need to be plugged up as soon as they arise. Big chance of that now, with a Republican majority in Congress.

  8. nomad says:

    Ah yes. “The stupidity of the American voter.” This is exactly what the guy, MIT Professor Jonathan Gruber, who was involved in creating Obamacare said.

    “(l)ack of transparency” in designing Obamacare “a huge political advantage.”

    “And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass.”“We had to lie to” do it, he said. Truth and full disclosure would have exposed the scam. Enactment couldn’t happen politically. “You just literally (couldn’t) do it…Transparent financing? Transparent spending?”


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