Last week the Supreme Court ruled 6-3 on King v. Burwell and emphatically declared the Affordable Care Act (ACA) is here to stay. It upheld the provision of ACA that provides subsidies to millions of Americans in 36 states, including Ohio, where the Health Insurance Marketplaces are set up by the federal government.
Why are doctors involved in this fight? Doctors are in the front line of fire and we care that patients have coverage and access to care. For those who do not have health insurance through their workplace or through Medicare, the ACA provides two options. There is Medicaid for the very lowest income citizens and there are competing private health insurance plans available for purchase from health insurance exchanges, also called marketplaces. Thanks to the ACA, last year 8.8 million Americans received health coverage through health exchanges and over 16.4 million remarkably have signed up as of 2015. A key strategy of the ACA’s goal of expanding coverage, especially to the working poor, is to use a sliding scale to subsidize the cost of premiums for the private plans purchased through the exchanges.
In King v. Burwell, King claimed that the ACA requires such subsidies only in state health care exchanges. Thirty-six states, including Ohio, declined to set up their own exchanges and instead decided to let the federal government set up exchanges for their states. Most legal experts agreed that King v. Bur-well is about semantics. It is clear from the rest of the ACA that the law means to provide subsidies to Americans in states such as Ohio where the exchange was created and is run by the federal government as well as to provide subsidies in states such as Kentucky that set up their own exchanges. This case is about focusing on a few words in one sentence of the law and ignoring the clear intent of the rest of the law. This case is about hurting those who need health care and who would lose their health insurance without a tax credit. Because King v. Bur-well was not upheld by the Supreme Court, more than 8 million Americans can stay with their insurance and 10,000 would not have to die annually because of lack of health coverage.
Our country has struggled for more than 100 years to find a way to make sure patients don’t die because they don’t have enough money. We have made progress we can all be proud of. In 1965, the Medicare and Medicaid Act was signed into law and thousands of lives are saved every year because of it. On March 23, 2010, the landmark ACA was passed. For the first time in American history, our country can say that it will no longer accept anyone dying for lack of money. The 6-3 ruling confirmed and reaffirmed that the ACA is about improving health and saving lives, not to worsen or destroy them. The SCOTUS has now spoken twice. The ACA is the law of the land, and it is here to stay. So, let’s stop the frivolous repeal attempts. Let’s work on expanding Medicaid to the rest of the nation, and build on the success of countless benefits and protections of millions of Americans.
As a physician, I am proud of my profession, and thank you to the U.S. Supreme Court for siding with my patients.
Donald Nguyen, M.D., is a pediatric urologist in Beavercreek