The Supreme Court will hear oral arguments in the case of King v. Burwell on March 3, and the healthcare industry will be watching the proceedings very, very closely.
The case was primarily crafted by the Cato Institute, a libertarian Washington, DC think-tank founded by California investment manager Edward Crane and industrialist Charles Koch (of the Koch Brothers—yes, those Koch brothers), in 1977. At issue is an IRS rule regarding how tax credits and subsidies are supposed to be administered, with the Cato-backed plaintiffs arguing that the awarding of subsidies to ACA exchange customers is against the law and unconstitutional.
The plaintiffs have been defeated in multiple court decisions, leading them to appeal to the Supreme Court to have the law providing subsidies stricken down. If the plaintiffs were to convince SCOTUS to do so, it could have a catastrophic effect on patients, as well as the healthcare industry as a whole. How do we know? Well, groups representing almost every healthcare stakeholder have filed friend of the court amicus briefs practically begging the Supreme Court to deny the appeal. These groups, according to a posting on the website of patient advocates Families USA, include:
Members of Congress who wrote the ACA
While not personally affected by an adverse ruling, the members of Congress who authored the law and chaired the key health committees in 2010 argued that they always intended for tax credits to be available in all states—a key argument for the Court to consider in its ruling.
Consumers with serious and life-threatening health problems
In an attempt to share with the Court how their health and their lives are at stake, consumers with serious health conditions and who receive premium tax credits from states with federally-run marketplaces told their very personal stories.
Nearly half of all US states
Twenty-two states and the District of Columbia (including states such as Mississippi and New Hampshire that have traditionally opposed the ACA) argued that Congress never informed states that they might be denied tax credits if they didn't set up state-run health insurance exchanges, and emphasized the potential harm their residents would face if tax credits were withdrawn.
Women
Women's organizations, led by the National Women's Law Center, described how important premium tax credits are for ensuring that women, who traditionally have had trouble accessing health insurance, can get the health care they need.
Patients with chronic diseases
Organizations representing patients with cancer, diabetes, heart disease, and multiple sclerosis explained that being uninsured puts these patients at both financial and medical risk.
Community health centers
Primary care associations representing hundreds of federally qualified health centers pointed out how tax credits allow them to treat more people in need of healthcare.
People living with HIV/AIDS
Groups and individuals from around the country that represent those living with HIV/AIDS describe how the ACA's premium tax credits allow individuals to live—and not die—with the disease.
Health insurance companies
America's Health Insurance Plans, the trade association for the health insurance industry, described how an unfavorable court decision would destabilize the health insurance market and raise premiums across the board for all enrollees.
Hospitals
The American Hospital Association, the Hospital Association of America, and the Catholic Health Association (which represents Catholic hospitals) each filed a brief explaining how the elimination of premium tax credits would devastate hospitals' abilities to serve the poorest Americans.
Children
According to a group of children's advocacy groups and doctors, if the Court rules unfavorably, a different section of the Affordable Care Act—one that addresses access to the Children's Health Insurance Program (CHIP)—is also put at risk.
Small Businesses
Groups representing small business owners tell the Court that tax credits encourage Americans to take the risk of starting their own business.
Is there anyone left? Look, we understand that it's nigh impossible to talk about healthcare without talking about politics. Anyone who can read knows who is in favor of the ACA and who is not, but the 11 groups above don't care. They represent liberals and conservatives, as well as people who don't identify as either, and they are using their collective voices to state the obvious: Making a key funding portion of a law that is already in effect illegal will leave millions at risk without healthcare coverage and without treatment options. It will create a mess in which people may well die.
So, we'll all be watching over the next few months as the Supreme Court of the United States makes its decision, hoping they will choose to place patients' lives above politics.