The Supreme Court Wednesday heard oral arguments in a case that could throw a wrench in the implementation of the Affordable Care Act. Meanwhile, Congressional Republicans are working on a “plan B” if the court strikes down the ability of the federal government to offer health-care subsidies to millions of people in 37 states where there are no state-run exchanges.
The Supreme Court was slated to hear arguments in the case, King v. Burwell, from both attorneys representing a Virginia man named as a plaintiff and the federal government, representing Sylvia Mathews Burwell, the U.S. Secretary of Health and Human Services.
The plaintiffs are arguing that with the words, “exchanges established by the state,” the ACA incentivized states to establish their own exchanges, or else their citizens would not be allowed to get subsidies to help lower the cost of health insurance, the International Business Times writes. When 37 states opted not to set up their own exchanges, the federal government created a national exchange for people in those states to buy insurance, offering them subsidies.
The plaintiffs are expected to argue that the case hinges on what Congress intended, and not how the IRS subsequently amended the ACA to enable the federal exchange to offer subsidies to people in those 37 states.
The government, on the other hand, will say that the court should consider the wording in the context of the rest of the law and how it was ultimately implemented, or else millions would lose their subsidies and might not be able to afford insurance.
The IBT wrote that if the law is overturned, “the government has said it has no plan B.”
“A decision against the administration in the King case would cause massive damage,” Burwell reportedly wrote in a letter to members of Congress on Feb. 24, according to the IBT. “We know of no administrative actions that could, and therefore we have no plans that would, undo the massive damage to our health care system that would be caused by an adverse reaction.”
However, three Senate Republicans have proposed an alternative to the ACA in case the Supreme Court strikes down the subsidies. Many of the 37 states which do not have exchanges are led by Republican governors.
Under the GOP’s plan, there would be no individual or employer mandates, but those who already have government insurance through Medicaid would be given tax credits to buy private plans, and upper-income families would no longer qualify for financial help, according to The Hill.
The three senators proposing the ACA alternative are Senate Finance Committee Chairman Orrin Hatch, House Energy and Commerce Chairman Fred Upton, and Sen. Richard Burr of North Carolina.
“Under our plan, every American will be able to access a health plan, but no American is forced to have health insurance they do not want,” according to the members’ nine-page document.