Friday, June 12, 2015

What's at Stake in King v. Burwell

by Fran Quigley, guest contributor

I have a thick stack of detailed notes and a Power Point presentation, all prepared for use in teaching about the implications of the King v. Burwell case the U.S. Supreme Court is ready to decide any day now.

I explain to students that this is the case where a four-word phrase in the 900-page text of the Affordable Care Act is the subject of a legal challenge designed to knock the underpinnings out from under our new healthcare law.

The plaintiffs focus their argument on a portion of the statute that allows tax subsidies to be provided to some lower-income people when health exchanges are “established by the state.” They contend this means that subsidies have been unlawfully provided to 6.4 million people who have purchased their insurance through federally-operated exchanges. That is the only option available in the 34 states—Indiana included—that did not set up their own exchange.

My class presentation covers how Indiana’s Attorney General Greg Zoeller, with the support of Governor Mike Pence, submitted a friend of the court brief in support of the plaintiffs in the Supreme Court case. Despite the fact that a ruling could cut 159,000 Hoosiers off from tax subsidies that average $320 per month, Zoeller and Pence have lined up Indiana with disgruntled activists who vowed when the Affordable Care Act passed to “drive a stake through its heart.”

I am able to teach the story of King v. Burwell fairly well. But if I could just bring Kendra Bush to class, I would pitch most of my notes aside. Because Kendra Bush represents the best of the admittedly imperfect Affordable Care Act, and also represents the potential human cost of the King v. Burwell challenge.

Kendra Bush is an Indiana home healthcare worker, a 48 year-old woman who spends six days a week performing the physically and emotionally challenging task of caring for a half-dozen different persons who are either elderly or have disabilities.

It would be hard to think of a more important job, but it is one that pays poorly. In a sad irony, healthcare provider Bush has gone without health insurance before, avoiding doctor visits because she could not afford to pay out of pocket.

But that has all changed. Thanks to signing up for the federal exchange, Bush now has access to healthcare. Since her insurance premium is mostly covered by the subsidies, she pays only $24 per month for coverage. Having health insurance has provided more than just piece of mind. When a recent mammogram showed a suspicious spot in Bush’s breast, she was able to get it checked out and resolved right away. None of that would have happened during her days of being uncovered.

“If these subsidies go away, it is going to hurt a lot of us,” Kendra Bush says. “For some people, it will mean choosing between health care and having something to eat or pay their rent. And it shouldn’t be that way.”

I couldn’t have said it better myself.

[NB:  This essay previously appeared in the Indianapolis Star.]

https://lawprofessors.typepad.com/human_rights/2015/06/the-stakes-in-king-v-burwell.html

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