The Supreme Court justices Wednesday appeared split as they heard oral arguments in King v. Burwell, the latest major challenge to the Affordable Care Act. Get highlights from inside the court here and a complete transcript here.
At issue in the case — the most serious challenge to the law since the justices upheld it as constitutional in 2012 — is whether health-insurance subsidies are available for qualified individuals only if they purchase insurance through an exchange established by a state, not the federal government.
So, what happens after oral arguments?
The court will meet on Friday and vote on the case. This will probably determine the outcome, though the public may not know the result for several months.
Justice Ruth Bader Ginsburg has said cases are most often decided based on the written briefs submitted to the justices. Sometimes, but not often, oral arguments will affect the outcome of the decision, justices say.
And when will we know what they decide?
A case as important as this one tends to take some time. The ruling will be issued once the majority has agreed upon an opinion and, if there are dissenters, when those opinions are ready as well. The court’s only deadline is that it tries to finish its work by the end of June.
What happens if the justices rule against the administration?
About 8 million people could lose health insurance if the subsidies from a federal exchange are no longer allowed, according to recent estimates. Without subsidies, it’s expected that the lower-income and healthier enrollees would quickly drop coverage, leaving just the sickest patients who need coverage the most. Insurers would look to raise their rates to cover the costs, pricing even more people out of coverage and causing problems for the individual insurance market outside of just the exchanges.
One note: Most people who would lose their subsidies in such a ruling would be spared from the penalty for not having health insurance since they don’t earn enough.
If the justices overturn the subsides, would there be a fix?
The easiest fix would be for Congress to pass a law that says federal exchanges can provide subsidies — but Republicans opposing the ACA would never go for that. A handful of Republican lawmakers, in two separate proposals this week, raised the idea that they would offer temporary financial relief to those losing subsidies. However, they haven’t provided detailed plans, and it’s unclear how much support they have within the party for their proposals. The Obama administration, for its part, insists it won’t be able to fix anything — perhaps an effort to avoid signaling to the justices that a ruling against subsidies would be easy to rectify.
In states with exchanges run by the federal government, Republican governors and state lawmakers could find themselves taking the blame if millions of their citizens are suddenly cut off from coverage. States could still establish their own exchanges, ensuring that their citizens receive subsidies, but that could be a lengthy, expensive and politically difficult process. So that means states may look to possible workarounds to establish an exchange in minimal time and cost. The state-level response will depend, though, on the details of the court’s decision and whatever direction comes from Congress or the Obama administration.
But a temporary fix could also come from the Supreme Court itself: Justice Samuel Alito suggested that the court could delay the decision from taking effect until 2016 to give states and Congress time to react.