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In Obamacare case, the views of lawyers and hospitals

Early next month, the U.S. Supreme Court will hear oral arguments in a case that will determine whether the basic framework of the Affordable Care Act survives.

We’ll have a lot more about the Virginia case as the arguments near, but the single issue is the wording of the 2010 law and whether it allows taxpayer subsidies for all people who buy health insurance on a marketplace known as an exchange.

Conservatives like Oklahoma Attorney General Scott Pruitt argue that the wording of the law makes the subsidies available only to people who live in a state that established its own exchange.

The Obama administration and the Democrats who wrote the law contend the subsidies were intended to help people afford health insurance no matter what kind of exchange a state has.

According to the Kaiser Family Foundation, 37 states have federal exchanges. So if those who challenged the law prevail, subsidies would only be available to people in 13 states.

In the last few weeks, dozens of briefs known as amicus, or friend-of-the-court briefs, have been filed in the case by groups and individuals with an interest in the case.

Pruitt _ the first to challenge the subsidy language in federal court _ has filed a friend-of-the-court brief on behalf of Oklahoma, Alabama, Georgia, Nebraska, South Carolina and West Virginia. Pruitt’s case didn’t make it through the lower courts fast enough to be considered by the high court.

Pruitt says in his brief that Congress intended for states to receive incentives to establish their own exchanges and those incentives were the tax credits.

The interpretation by the IRS in extending the subsidies to those buying insurance on federal exchanges, Pruitt argues, “cannot be squared with the plain text of the statute.”

The authors of the law and the administration say the whole point was to make health insurance affordable so they never intended to limit the subsidies to a certain type of exchange.

That’s the legal issue before the court.

But some of the groups filing briefs want the justices to know about the impact their ultimate decision may have. And these briefs, from health insurance companies and health care providers afford some insight into how the law known as Obamacare is working.

The group representing the nation’s hospitals and a major hospital chain filed briefs arguing that the Affordable Care Act is working as intended and that millions of people would lose insurance if those challenging the subsidies are successful.

“We will not mince words. Petitioners’ position, if accepted, would be a disaster for millions of lower- and middle-class Americans,” the American Hospital Association brief says.

“The ACA’s subsidies have made it possible for more than 9 million men, women and children to have health care coverage _ some for the first time in years; some, no doubt, for the first time in their lives.”


The American Hospital Association brief is here.


Hospital Corporation of America brief is here.

A brief filed by America’s Health Insurance Plans _ which represents the companies that sell health insurance _ says throwing out the subsidies in states like Oklahoma “would alter the fundamental dynamics of those markets in a manner that would make insurance significantly less affordable even to those who would not rely on subsidies.

“It would leave consumers in those States with a more unstable market and far higher costs than if the ACA had not been enacted.”



Chris Casteel

Chris Casteel began working for The Oklahoman's Norman bureau in 1982 while a student at the University of Oklahoma. Casteel covered the police beat, federal courts and the state Legislature in Oklahoma City. From 1990 through 2016, he was the... Read more ›