Briefing: Fate of Obamacare may hinge on Supreme Court ruling this month

The Supreme Court will decide monumentally important cases in the next 29 days -- the constitutional basis, or lack of it, for gay marriage, the legality of Obamacare, and a lethal injection case out of Oklahoma.

The future of the Affordable Care Act may well hinge on the court's decision this month. And it will come this month. June is the final month of the court's term, and the justices typically withhold their most important rulings for the end of the term. As a rule in June, they issue orders on Mondays, so it's possible that Monday, June 29, could be the big day for both Obamacare and same-sex marriage.

The case: King v. Burwell

This case concerns four words — “established by the state.” Obamacare requires all adults to obtain health insurance, but it also seeks to make insurance affordable. For the poor, the law mandated a large-scale expansion of Medicaid. For working people without coverage, the law provided for an “exchange,” a Web-based marketplace, where they could buy individual policies. The law also created a tax credit to help pay for the policy. Now here’s the rub: 34 states, including Georgia, decided not to create their own insurance exchange, opting instead to use the one built by the federal government. And that is the heart of King v. Burwell: the plaintiffs say that the law specifies that citizens will receive tax credits to use on an exchange “established by the state.” The plaintiffs argue that the tax credits are therefore illegal in any state that did not create its own exchange. David King is one of four Virginia residents who sued over the four words. Sylvia Burwell is the secretary of the Health and Human Services Department.

Potential impacts in Georgia

  • Of the 541,000 people in the state who signed up for insurance on the exchange during the latest enrollment period, 90 percent received a tax credit to help them afford the policy. Many, perhaps most, would be unable to afford the insurance if the tax credit were rescinded.
  • Because Georgia refused to expand Medicaid, hundreds of thousands of poor people here have continued to go without insurance. If the court disallows the tax credits, hundreds of thousands more will be forced to give it up.
  • Some states have the option of quickly creating their own exchanges to comply with the law, if it comes to that. Georgia passed a law prohibiting the state from doing so.

The fate of Obamacare

In its first major ruling on Obamacare, the court overturned a provision that required the states to expand Medicaid. Instead, the states were given the option of expanding. In Georgia and the other states that chose not to expand Medicaid, that effectively kicked one pillar out from under Obamacare. A ruling that disallows the tax credits would kick out another one, leaving the law near collapse.

Read our briefing on the same-sex marriage case pending before the court.

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