In a Perfect World


In a perfect world, there would be no need to reform our healthcare system in the United States. As the wealthiest and most ingenious nation in the history of the world, we would have already figured out a way to guarantee access to medical care for all citizens, while driving the quality and efficiency of care higher and its costs lower. But alas, we do not live in a perfect world.

Instead, we have been working for four years to implement the Affordable Care Act. The ACA was the most significant piece of legislation to affect our healthcare system since the enactment of Medicare and Medicaid. No matter what your opinion on the law itself, the goal of providing affordable healthcare insurance to our nations uninsured is a worthy one. And like all worthwhile efforts of this magnitude, the ACA has been met with challenges both legitimate and paltry.

Last week there were contradictory verdicts in the ongoing lawsuits concerning the ACA. The difference with these latest cases however, is that they involve actual consumer checkbooks and the law’s opponents are working very hard to ensure that the Affordable Care Act becomes anything but.

Under the 2010 law the states were encouraged to set-up state sponsored health insurance marketplaces where consumers could go to shop for coverage and compare prices. The federal government would step in to offer subsidies to people meeting certain income criteria to place the insurance coverage within their reach. For people in states that refused to participate – like Texas – the federal government would allow those consumers access to the federal marketplace and likewise subsidize a portion of their premiums.

Here’s the rub: there is one sentence in the text of the ACA that stipulates premium assistance would only be made available to those consumers participating in a state run marketplace. In two separate lawsuits addressing the same question, we have two different federal courts issuing conflicting rulings. In Virginia, the three judge panel of the D.C. Circuit Court of Appeals ruled that the law must stand as written, ergo, if you bought your policy through the federal exchange – as everyone in Texas had to do – the government is now barred from giving you your subsidy.

[image link=”” class=”” title=”” src=”” alt=”” align=”right” image_frame=”false” wrapper=”false” wrapper_class=”” wrapper_style=”” width=”600″ height=”346″ size=”full”]This could leave about 4.5 million people without the insurance payment assistance they were promised and create a devastating domino effect on ACA itself. The law is intended to spread out the cost of healthcare across as wide a pool of people as possible, thus bringing down the overall cost. If 4.5 million people are ripped out of that pool, we’re all going to be paying far more for our health insurance, but not as much as they will be.

The Fourth Circuit Court ruled that the language was ambiguous and that the intent of Congress in authoring the law was clear – to provide payment subsidies to consumers. This ruling gave the federal government permission to proceed with the financial assistance to qualifying consumers.

So the ACA is once again stuck in a litigious dead end. At this point, one thing is certain: the attorneys involved in these suits will not need help paying for their insurance premiums. As for the rest of us . . . time will tell. Or rather, the next court ruling will.

The Justice Department filed an immediate appeal to have the case in the DC court reconsidered by all 11 judges. Regardless of that outcome however, there will probably be a final appeal heard in the Supreme Court. But after that, the ruling stands. Perfect world or not.