To Your Health! Well, Not So Fast, There ...

Among the many other weighty issues before the Supreme Court this session is the meaning of four words buried deep in the thousands of pages of the Affordable Care Act*: “established by the State.” A decision on what those four words mean in the context of the law will have an enormous impact on whether or not the law as a whole will be able to survive, and whether or not many thousands, if not millions of people will be able to afford health care in the years to come.

Here’s how we got our semantic knickers into this twist …

The Affordable Care Act (we’ll call it “ACA” for short) provides for the establishment of "exchanges" through which individuals can purchase competitively priced health insurance, and authorizes federal tax credits** to low- and middle-income Americans to help offset the cost of health insurance policies, which tend to be higher than many people of modest means can afford. Today, 16 states and the District of Columbia*** have set up their own exchanges; the other 34 states depend on exchanges run by the federal government. The Internal Revenue Service, which implements parts of the ACA, has ruled that the tax credits (also called subsidies) apply to all exchanges, state or federal. The plaintiffs in the case now before the Supreme Court say that because a subsection of the law contains the words "established by the State," the law intends subsidies to be available only to people living in states that set up their own exchanges ... not to people who purchased their insurance through a federal government-run exchange.

The implications of the decision are clear: if the court rules in favor of the plaintiffs, millions of people who live in the 34 states using federal exchanges will no longer be able to use federal tax credits to purchase their insurance, and may thus lose it.

It seems to me that something has been lost in the endless arguing over the ACA, and it revolves around the meaning of a single word, rather than the four the Supreme Court is considering. That word is “affordable.”

In case you haven't noticed, health care in America is expensive. Millions of low and middle-income Americans cannot afford it. Many have full or part-time jobs that do not offer medical or dental insurance benefits, and many others don’t have jobs, period … and neither can afford sky-high insurance premiums. Even people with insurance coverage can be wiped out by a single catastrophic medical expense.

The reasons for the huge cost of health care are many: medical schooling is expensive, modern diagnostic equipment is expensive, drugs are expensive, and malpractice insurance is an enormous burden for medical professionals, driven up by enormous judgements awarded to plaintiffs in malpractice suits. Everything about our present health care system drives up the cost far beyond what many people can afford, and the burden of paying for those who cannot afford their own care is indirectly borne by everyone else in terms of higher insurance costs and, for businesses, loss of employee productivity.

Whether you love the ACA, like parts of it but not others, or hate it on principle, you have to admit one thing: it represents an attempt to fix a serious problem. Most everyone agrees that the law is flawed in one way or another, but it seems to me that the answer is not to work feverishly to kill it … the answer is to propose something better to replace it****. I’m still waiting for the GOP to do that.

Until then, good luck if you get sick.

Have a good day. Be here tomorrow, when we'll announce this month's Left Cheek Ass Clown of the Month.

Bilbo

* That’s “Obamacare,” for those of you who prefer to call it by a more disparaging name.

** I have an issue with the idea of “tax credits,” but that’s a discussion for another post.

*** Technically not a “state,” but not for want of trying.

**** The answer is not "tax credits." See ** above for preview of an upcoming rant.