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Obamacare Aid for Plan Buyers on U.S. Exchange Overturned

By Andrew Zajac
July 22, 2014 6:36 PM EDT 899 Comments
People wait in line to see an agent from Sunshine Life and Health Advisors as the Affordable Care Act website is reading, "HealthCare.gov has a lot of visitors right now!" at a store setup in the a mall on March 31, 2014 in Miami.
Photographer: Joe Raedle/Getty Images
People wait in line to see an agent from Sunshine Life and Health Advisors as the Affordable Care Act website is reading, "HealthCare.gov has a lot of visitors right now!" at a store setup in the a mall on March 31, 2014 in Miami.

President Barack Obama’s health-care overhaul suffered a potentially crippling blow as a U.S. appeals court ruled the government can’t give financial assistance to anyone buying coverage on the insurance marketplace run by federal authorities.

The decision, if it withstands appeals, may deprive more than half the people who signed up for Obamacare the tax credits they need to buy a health plan.

The government will immediately seek review of the court’s decision and in the meantime nothing has changed for people getting premium tax credits, Justice Department spokeswoman Emily Pierce said. A White House official said the U.S. will seek a review by the full appeals court, where seven of the 11 judges were nominated by Democratic presidents, including four by Obama. The judges didn’t grant the plaintiff’s request for a suspension of the tax credits, the official said.

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The way Congress wrote the Patient Protection and Affordable Care Act makes clear that the subsidy is available only to consumers who bought plans on state-run exchanges, the U.S. Court of Appeals in Washington ruled today, rejecting a rule by Internal Revenue Service setting up that system.

The law “unambiguously forecloses the interpretation embodied in the IRS rule and instead limits the availability of premium tax credits to state-established exchanges,” U.S. Circuit Judge Thomas Griffith wrote for the majority of a three-judge panel.

‘With Reluctance’

The judges reached their conclusion “with reluctance,” Griffith, a appointee of Republican President George W. Bush wrote. He was joined A. Raymond Randolph, who was nominated by President George H. W. Bush, also a Republican.

The Fate of Obamacare

“Our ruling will likely have significant consequences both for millions of individuals receiving tax credits through federal exchanges and for health insurance markets more broadly. But high as those stakes are, the principle of legislative supremacy that guides us is higher still,” Griffith wrote.

U.S. Circuit Judge Harry Edwards, an appointee of Democratic President Jimmy Carter, dissented, calling the case a “not-so-veiled attempt to gut” Obamacare.

Edwards said his colleagues accepted opponents’ “myopic construction” of the law, defied the will of Congress and issued “a judgment that portends disastrous consequences.”

Only 14 states and the District of Columbia have opted to set up their own marketplaces, making delivery of tax credits via the federal exchange crucial to meeting the health-care plan’s goal of broadening coverage in the U.S.

Bigger Pool

The plan’s success hinges on enlarging the pool of the insured, including those of modest means who need financial aid, to subsidize insurance costs for those who are ill.

Of the more than 8 million people who picked an insurance plan on the exchanges from October through April 19, 5.4 million selected one from the federal marketplace, according to a report by the U.S. Department of Health and Human Services.

According to the report, 85 percent of those picking a plan qualified for subsidies that reduce their premiums.

At least three other challenges to the health-care tax credits are percolating in federal courts in Virginia, Oklahoma and Indiana.

Arguments on an appeal of a ruling against opponents of the tax credits in Virginia were held May 14 in Richmond, Virginia.

The full circuit court in Washington will reverse the decision and the appeals court in Richmond, Virginia, will do the same, said Timothy Jost, a law professor at Washington & Lee University who has tracked implementation of Obamacare.

No Division

“There’s not going to be a division of the circuits, ultimately,” he said.

The health-care overhaul was signed into law by Obama in March 2010 after passing Congress with no Republican votes.

It’s been under political and legal assault ever since while plagued by computer failures that impeded sign-ups on state and federal exchanges.

In June 2012, the law was narrowly upheld by the U.S. Supreme Court which ruled that Congress has the power to make Americans carry insurance or pay a penalty. The high court didn’t rule on, or consider, the question of whether the law allows subsidies for plan buyers on the federal exchange.

The Supreme Court on June 30 ruled that closely held companies can claim a religious exemption from the requirement that they offer birth-control coverage in their worker health plans. That case, involving the craft-store chain Hobby Lobby Stores Inc. was among dozens of suits spawned by Obamacare’s contraceptive mandate.

Insurance Marketplace

Today’s ruling applies to a portion of the law making financial aid available to income-qualified people who buy their health insurance on a marketplace “established by the state.”

The government contends that when considered with other parts of the law, this language covers marketplaces set up by states themselves and by the federal government when it acts in place of states.

The IRS in May 2012 issued a rule making that point explicit. Financial aid, in the form of tax credits, would be available to taxpayers who obtain coverage on the federal exchange because that “is consistent with the language, purpose and structure” of the Affordable Care Act, according to the regulation.

No Sense

The government argued to the appeals court that limiting the credits to the 14 state exchanges makes no sense because it flies in the face of the law’s aim of reducing the number of uninsured.

Further, according to government lawyers, many sections of the Affordable Care Act anticipate the issuance of tax credits through federal exchanges.

For example, the law obligates exchanges to report tax information to the IRS, a requirement that would serve no purpose “if federal exchanges were not authorized to deliver tax credits,” government lawyers wrote court papers filed at the appeals court.

Opponents of Obamacare, including those who brought the Washington case, argued that the court is bound by the language of the law limiting the tax credits to customers of state exchanges. The language was deliberately chosen to induce states to set up exchanges, lawyers for opponents told the appeals panel.

The lawsuit was brought by four individuals and three businesses from six states that didn’t set up exchanges.

They contend they’re being financially harmed by the requirements either to buy insurance or to offer it to their employees.

The case is Halbig v. Sebelius, 14-5018, U.S. Court of Appeals for the District of Columbia (Washington). The Virginia case is King v. Sebelius, 14-1158, U.S. Court of Appeals for the Fourth Circuit, (Richmond, Virginia).

To contact the reporter on this story: Andrew Zajac in Washington at azajac@bloomberg.net

To contact the editors responsible for this story: Michael Hytha at mhytha@bloomberg.net Fred Strasser, David E. Rovella

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