Hallelujah, for the second time! As a not entirely unexpected outcome, the Supreme Court this week ruled in King v. Burwell. This 6-to-3 decision upholds the authority of the US Department of Health and Human Services to pay insurance premium subsidies under the Affordable Care Act (ACA) to persons who seek insurance through the federal health insurance marketplace.
This decision has very broad implications. The Department operates the health insurance marketplaces for 34 states, and 85 percent of those insured actually receive premium subsidies. Families USA estimated recently that up to 6.4 million persons could lose their health insurance if the Supreme Court had struck down this provision.
This Court decision is a great victory for social justice. If we are to reduce unseemly disparities in health status and health care in the United States, and if we are to promote better health equity, then it is essential that the poor and near poor have access to good health insurance coverage. Such coverage, with sliding insurance premium subsidies, has been made available to all persons with incomes between 100 percent and 400 percent of the federal poverty level through the ACA.
Because the Court vote was 6-to-3 and because the language used in the decision was strong and did not rely on prior Court precedent, we can assume that future Court challenges to the ACA will be less likely.
Currently, slightly more that 11 million persons receive their health insurance coverage through a state health insurance marketplace, and about 6 million persons receive their coverage through the state Medicaid expansion. Going forward, we will need to more than double these current numbers to approach the original ACA goal of providing health insurance to 40 million more Americans.
The issue of health insurance enrollment is particularly acute for persons with mental health and substance use conditions, since ample evidence exists that these persons are the most difficult to enroll and keep enrolled in health insurance.
The Court decision favors the American people and will help us achieve the important goal of enrolling more citizens in health insurance, including those with behavioral health conditions.