Minnesotans fortunately watched from a protected perch as the latest legal challenge to the Affordable Care Act — King vs. Burwell — played out and then finally came to dramatic conclusion Thursday with the U.S. Supreme Court’s second ruling in support of the law.
Thanks to this state’s early embrace of the landmark 2010 legislation, access to affordable health care coverage did not hang in the balance here as the high court weighed the fate of the ACA’s subsidies to help people pay monthly insurance premiums. The King lawsuit contended that Congress only intended the aid for states like Minnesota that set up their own health insurance marketplaces. That meant people in 34 other states who rely on the federal government’s Healthcare.gov website could have suddenly been ineligible for monthly premium payment assistance.
In remarkably plain language, the majority opinion dismissed the absurd argument at the heart of the politically motivated lawsuit — that an ambiguously worded description buried deep within the sprawling law was a legal time bomb. Writing for six justices, Chief Justice John Roberts sensibly concluded context is critical. He noted that Congress ensured that consumer insurance protections, such as pre-existing condition coverage, applied in all 50 states.
The mechanics of the insurance market require that other elements of the law, such as the requirement to buy coverage and the subsidies to make that coverage affordable, be in place as well. Otherwise, an insurance “death spiral” occurs in which only sick people buy plans, and premiums skyrocket because the risk pool of policyholders is too small to spread out costs. “It’s implausible that Congress meant the Act to operate in this manner,’’ Roberts wrote.
Thousands of Minnesotans who receive the new subsidies to help them buy health insurance would have been protected — at least for the time being — had the ruling gone the other way. But nearly 7 million people in 34 other states potentially faced the sudden loss of their new subsidies and coverage.
The brunt of this would have been felt mostly in poorer Southern states. But those living in North and South Dakota, Iowa and Wisconsin were also at risk because their state governments relied on Healthcare.gov, too. The nation would have taken a disgraceful step backward at a time of historic coverage gains. The “fixes” Republicans have promised also would not have prevented massive disruptions in the insurance marketplace, potentially unraveling the law completely.
The ACA has survived after three national elections and the two Supreme Court challenges. Its opponents need to move on. “Death panels” have not materialized, as they predicted. Nor has the economy been brought to its knees. The hysteria over the law isn’t supported by the facts.
The reality is that family, friends and neighbors have benefited and will continue to do so. Alan Overland, a dairy farmer from Sturgeon Lake, Minn., is among them. Competition among insurers on MNsure, along with the ACA subsidies, has helped reduce his family’s premiums by about $400 a month and cut their annual deductible, significantly easing the pressure on his 24-head milking operation’s bottom line.
It’s time to acknowledge this historic law, while not perfect, is nevertheless an accomplishment. Those who battle on to tear it down are behind the times.