Access to Health Care for Millions in the Balance as US Supreme Court Reviews Federal Subsidies for Insurance | Law and Medicine | JAMA Forum Archive | JAMA Network
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JAMA Forum Archive, 2012-2019: Health policy commentary from leaders in the field
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Access to Health Care for Millions in the Balance as US Supreme Court Reviews Federal Subsidies for Insurance

When the Supreme Court narrowly upheld the individual health insurance mandate in National Federation of Independent Business v Sebelius (2012), the future of the Affordable Care Act (ACA) appeared secure. However, the case opened the door to 22 states refusing to expand Medicaid coverage for the poor—a major setback for health equity.

In addition, 19 states opted for fully federally operated exchanges (marketplaces to purchase insurance), and another 15 for a hybrid system, with the federal government retaining ownership. When states decided not to form state-run exchanges, few experts expected adverse consequences.

But all that could change.

On November 7, 2014, the US Supreme Court agreed to hear King v Burwell, which challenges an Internal Revenue Service (IRS) ruling that ACA subsidies could be granted to individuals purchasing insurance in federally operated exchanges. If the Court were to render these subsidies unlawful, it would threaten access to health care for millions and undermine the integrity of the ACA.

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