Now, in the case of King v. Burwell, the meaning of six words in a thousand-page law is under scrutiny. Those words could determine whether millions of Americans can afford to buy health insurance.
The law states that people who sign up for health coverage through “an exchange established by the state” qualify for government subsidies.
But what is an exchange established by the state, you ask.
The Obama administration says it’s every insurance marketplace set up by a government. That includes the federal government’s healthcare.gov. It’s used by the residents of about three dozen states.
But the lawsuit argues it’s only the 16 states and the District of Columbia that set up their own marketplaces.
If the challengers win, more than 6 million Americans would lose the subsidies that have helped them afford health insurance. So, if you bought your policy through healthcare.gov – the federal exchange – you would no longer receive that help.
What does this mean for the health insurance system? Healthier people would likely drop coverage if they lose financial help, which means insurers would raise premiums because they would be covering fewer, but sicker people. That would impact everyone who buys their own insurance in those states.
Of course, Congress could step in to clarify the confusing words. But many think that’s unlikely. Or some states might decide to create their own state-based insurance marketplaces. But that couldn’t happen overnight.
The justices are expected to deliver their decision in late June, just as the 2016 presidential campaign is kicking into high gear. So keep your eyes and ears open because this decision could affect you.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.