AFFORDABLE CARE ACT

Clashing rulings throw subsidies into question

Courts split on ‘Obamacare’ challenge

7/23/2014

Much was at stake Tuesday as courts debated whether the wording of the federal health-care law prevents the government from giving subsidies in states that use the federally run health insurance exchange.

Two federal appeals court panels issued conflicting rulings on whether the government could subsidize health insurance premiums for millions of Americans, raising yet more questions about the future of the health-care law four years after it was signed by President Obama.

To the ire of many Democrats and health-care reform advocates, a federal appeals court panel in Washington handed down a 2-1 decision Tuesday declaring that eligible residents of states that use the health insurance marketplace run by the federal government — like Ohio and Michigan — may not receive government subsidies for their premiums under the Affordable Care Act.

The ruling of the three-judge panel, part of the U.S. Court of Appeals for the D.C. Circuit, was not made by the full court, but if upheld, it could jeopardize billions in insurance subsidies.

Just hours after the panel issued its decision, the U.S. Court of Appeals for the 4th Circuit in Richmond, Va., issued a ruling that directly contradicted the D.C. panel’s findings and upheld the same subsidies.

Ohio and Michigan are two of three dozen states that did not set up state-run marketplaces for health insurance following the 2010 passage of the Affordable Care Act — dubbed Obamacare — leaving state residents to enroll under the law through the federal insurance marketplace.

The appeals court panel in Washington on Tuesday argued that the wording of the law prevents the government from offering financial assistance to eligible Americans in the 36 states that use the federal marketplace rather than state-run exchanges.

The court in Richmond came to the opposite conclusion.

Tuesday’s rulings will have no immediate impact on people enrolled under the health-care law, experts and advocates said.

And calling the D.C. panel’s decision incorrect, Obama Administration officials vowed Tuesday that eligible policyholders would continue to receive aid.

In the Toledo area, there was mixed reaction to Tuesday’s decision.

Jan Ruma, executive director of CareNet in Toledo, which provides health-care services on a sliding fee scale for eligible low-income Lucas County residents, said: “There are two conflicting decisions. We need to wait until it’s all sorted out.”

She said, “I’m not sure what happens next. If the D.C. ruling prevails, will it affect subsidies going forward or will it be retroactive?”

She said she hopes that a decision is made before the next open enrollment, which she expects will take place in November.

“I’m not sure it will be, though,” she said.

For now, Ms. Ruma said, “Our focus is on Medicaid because it is always open. Our message is for people with low incomes who are uninsured to visit benefits.ohio.gov to find out if they are eligible for Medicaid.”

She said Medicaid is not affected by the rulings.

U.S. Sen. Rob Portman (R., Ohio) said conflicting court rulings highlight the flaws and ambiguity of Obamacare.

“This is the predictable result of forcing a partisan piece of legislation through Congress without amendment, proper consideration, or bipartisan input.

“This broken legislation is making insurance more expensive and jobs harder to find, and now we learn the subsidies meant to ease the blow may not be available for millions of Ohioans,” he said. “The administration cannot fix Obamacare through ad hoc executive orders and administrative actions. Obamacare should be repealed and replaced with health-care reform that is patient-centered and consumer driven that decreases costs and increases access.”

U.S. Rep. Marcy Kaptur (D., Toledo) defended the law.

“The [Affordable Care Act] is the law of the land and 9 million more Americans who lacked health insurance now have accessed it,” she said. “If details of the act need to be refined through the courts, or Congress, that is to be expected. Let’s get on with making progress for America, and our people, not hindering it. I would guess all those judges have always possessed very good insurance plans. So should Main Street Americans.”

The Block News Alliance consists of The Blade and the Pittsburgh Post-Gazette. Madeline R. Conway is a reporter for the Post-Gazette.

Information from The New York Times was used in this report.

Contact Madeline R. Conway at: mconway@post-gazette.com or 412-263-1714.