SCOTUS upholds subsidies, industry shifts attention to other ACA fixes

The Supreme Court ruled Thursday that subsidies used to purchase health insurance on the federally facilitated marketplace are legal. The 6-3 decision in King v. Burwell means that tax credits continue to be valid in the 34 FFM states.

Also see: Burwell: ACA conversation should focus on health care, not politics

Now, it’s time to shift the conversation about the Affordable Care Act to focus on substance, Department of Health and Human Services Secretary Sylvia Burwell said earlier this month. Burwell said she wants to move in a direction “where we are all working together to improve affordability, quality and access.”

Also see: Employee benefit lobbyists lay out legislative agenda

While most of the discussion surrounding the much-anticipated case focused on subsidies, there are other issues that one employee benefit lobbyists wants to ensure Congress doesn’t overlook. Recently, the American Benefits Council released six legislative recommendations to improve the ACA and preserve employer-sponsored health care. Those included:

1)      Expanding health reimbursement arrangements  

2)      Ending the Cadillac tax

3)      Modify the employer shared responsibility requirement

4)      Simplify employer reporting requirements

5)      Repealing automatic enrollment requirements

6)      Improving Health Savings Accounts

 Also see: An in-depth look at King v. Burwell

On March 4, the Supreme Court heard oral arguments King v. Burwell, which challenged the legality of tax credits allowed to purchase health insurance under the ACA. The issue was the wording of the IRS rule that says individuals qualify for subsidies when they buy health insurance through an exchange “established by the state.”

The plaintiffs, four residents of Virginia — which uses the federal exchange — argued the law puts a financial burden on them. The plaintiffs argued that without tax credits, they wouldn’t be subject to the individual mandate due to a hardship exemption that says a person is exempt if the cheapest plan available costs more than 8% of the individual’s income. With the subsidies, they would be forced to buy insurance or pay the penalty.

The Obama administration has said the law’s intent is to provide subsidies for everyone, not just those who purchased coverage through a state-based exchange.

Also see: Halbig v. Burwell ruling  

This wasn’t the first time the Supreme Court ruled on the health care law. In 2012, the high court ruled 5-4 to uphold the ACA — in National Federation of Independent Business v. Sebelius — a case that focused on a requirement for most Americans to get health coverage or pay a penalty. The individual mandate, as it’s referred to, went into effect Jan. 1, 2014.

Lower court decisions were split on the issue. In July, the U.S. District Court for the Eastern District of Virginia upheld the validity of subsidies offered to individuals on the federal exchange — and on the same day, a three-judge panel on the D.C. Circuit Court of Appeals declared those same subsidies invalid. Less than four months later, the Supreme Court agreed to review the case.