The Supreme Court is expected to decide as soon as this week whether a main part of the Affordable Care Act (ACA) can survive.
Four residents of Virginia contend they were forced by the ACA to buy coverage because of subsidies they receive from the federal government. Their appeal rests on the words “established by the state,” a phrase in the law that the challengers say means that only people who buy coverage through marketplaces established by states—not through the federal health care marketplace—qualify for subsidies.
Virginia is among 34 states that use the federal marketplace. Absent the subsidy, the challengers charge they would be neither able nor required to buy health insurance. If the Court agrees, 6.4 million people could lose tax credits that help them afford coverage and, in most instances, keep them on the rolls.
The government calls the interpretation advanced by the challengers strained. Congress never intended to distinguish between federal and state exchanges in setting up subsidies, proponents of the law say.
Instead, the four words at issue constitute a vestige of an assumption—abandoned during the legislative process—that each state would establish an exchange. It later became apparent that some states would decline to set up exchanges, in which case the federal government made coverage available through HealthCare.gov.
More than 11 million Americans have signed up for health coverage since the ACA passed five years ago. In all, 48% of Americans say the law is working well or needs minor improvements, while 50% say it needs to be overhauled or eliminated, according to the latest NBC News/Wall Street Journal poll. That’s down from December 2013, when 57% of adults said the law needed to be recast.
Not surprisingly, support for the ACA divides along party lines. A survey last February by the Pew Research Center found that 87% of Republicans opposed the law while 78% of Democrats supported it.
According to the latest Gallup poll, people between the ages of 18 and 29, those who earn less than $24,000 a year, and black and Hispanic voters are most likely to say the law has helped them and their families.