The health care industry was hoping this would be the year it could move beyond the Obamacare fight in Washington and on to new priorities, such as improving drug development and patient care.

But the Supreme Court’s upcoming ruling in King v. Burwell threatened to derail those ambitions.

Industry advocates are concerned that no matter how the court rules on the legality of certain insurance subsidies provided under the law, the health care debate in Congress will once again become dominated by the political divisions over the Affordable Care Act (ACA).

“It has the potential for serious chaos and disruption,” said health care lobbyist Ilisa Halpern Paul, who represents hospital systems and health advocacy groups.

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The high court ruled on Thursday to preserve the subsidies to 6.4 million Americans in the 34 states that have federally run health insurance exchanges.  By a 6-3 vote, it affirmed an Internal Revenue Service ruling that the subsidies should be available not only in states that have set up their own exchanges, but also in states where consumers rely on the federal exchange.

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Before the ruling, Republicans were scrambling to figure out whether they should find a way to keep the subsidies in place until after the 2016 election when they hope a Republican president and GOP-controlled Congress can repeal the law in its entirety.

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Now, that concern is over. The legislative focus on the subsidies would mean all other health-related legislative initiatives that have gained traction recently are likely to come to a halt, at least temporarily.

“Many people are concerned that if the court reverses, that will consume the rest of the congressional agenda for the balance of the year, not just for health care but for everything,” said Eric Zimmerman, a health care lobbyist and lawyer at McDermott Will & Emery who represents hospitals and health systems. “You’re talking about something that’s not only going to be very time-consuming but also very divisive. You’ve got a pattern in Congress that’s unusually productive, Republicans and Democrats working together in a manner they haven’t in the last five or six years, on anything. That all goes out the window if the court reverses in King.”

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But the path toward legislative action isn’t clear just because Congress upheld the subsidies. Health care lobbyists worry that Republicans will refocus their efforts on repeal of the entire bill, a divisive tactic that could put an end to any tenuous bipartisanship that may have been forged on health care issues so far this year.

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At the top of the list that health policy wonks were excited to see Congress take on this year is the 21st Century Cures Act, a bill aimed at modernizing drug development. The bill would establish a $10 billion fund at the National Institutes of Health to support biomedical research, create a structure to accelerate approval for some therapies and improve access to data about diseases.

It was unanimously approved by the House Energy and Commerce Committee last month. Advocates for the bill, authored by House Energy and Commerce Chairman Fred Upton (R-Mich.) and Rep. Diana DeGette (D-Colo.), had been pushing to get it on the House floor before the King v. Burwell decision, but that timeline has been delayed until after the July 4 recess due to disagreements over how to offset its cost.

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Upton and DeGette on Wednesday expressed confidence about the bill’s passage.

“Our commitment is unwavering, and the patients fighting for this are unstoppable,” Upton said through a spokesman.

DeGette, through a spokesman, said she has “every confidence my colleagues will join me to make that happen.”

Other pieces of healthcare legislation moving through Congress include a series of bills approved by the House last week aimed at strengthening the Medicare Advantage program for seniors and a Senate Finance Committee markup Wednesday of a dozen bills that address rural community hospitals, physical therapy treatment, patient access to disposable medical technology and other health-related issues.

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Now the pending court ruling has industry officials in Washington worried about these legislative initiatives going much further.

“It’s almost been a welcome relief for folks to be doing things in the non-ACA healthcare policy space,” Paul said. “If you have strikedown of the subsidies, you then have all the oxygen in health policy, and money, needing to go toward what to do next with respect to addressing this coverage issue.”

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