Majority of U.S. Residents Favor Gov’t Action To Keep ACA Subsidies

A majority of U.S. residents would support congressional or state action to restore subsidies to help U.S. residents purchase coverage through the federal exchange if the Supreme Court strikes them down, according to a Kaiser Family Foundation poll released Wednesday, Kaiser Health News reports (Rovner, Kaiser Health News, 1/28).

Background

The high court in March will hear oral arguments in King v. Burwell. At issue in the case is that while the Affordable Care Act says subsidies are available to help certain U.S. residents purchase coverage offered "through an exchange established by the state," a May 2012 IRS rule allows the subsidies to be used in an exchange administered either by a state or the federal government. The plaintiffs argue that the IRS rule should be invalidated because it contradicts what Congress originally wrote in the ACA.  The court likely will release a decision by the end of June (California Healthline, 1/23).

If the court strikes down the subsidies, the ruling would eliminate about $28.8 billion in subsidies to 9.3 million individuals in 34 states in 2016, according to an Urban Institute analysis (Demko, Modern Healthcare, 1/28).

Poll Findings

The KFF poll surveyed a national representative sample of 1,503 U.S. adults from Jan. 15 through Jan. 21 via telephone (DiJulio et al., KFF poll methodology, 1/28).

Researchers asked respondents what should happen if the court strikes down the subsidies. The poll found:

• 64% of respondents thought Congress should restore subsidies; and
• 59% said states without their own exchange should create one (Kaiser Health News, 1/28).

Further, the poll found 82% of Democrats, 63% of independent voters and 40% of Republicans would support congressional action to restore the subsidies (DiJulio et al., KFF poll findings, 1/28).

The poll also found that relatively few respondents were aware of the case and its potential effect. Among respondents in states using the federal exchange:

• About one-third were aware their exchange was run by the federal government;
• 39% incorrectly said their state operates its exchange; and
• 28% did not know who ran the exchange (Kaiser Health News, 1/28).

No Decisions Yet by Lawmakers, Obama Admin

Top lawmakers in both houses of Congress have begun considering how to respond to the ruling, though no decisions have been made, according to AP/U-T San Diego. Meanwhile, Obama administration officials have not yet announced a plan for if the court ends the subsidies (Fram, AP/U-T San Diego, 1/27).

Advocacy Groups Fight Subsidy Challenge

In related news, several advocacy organizations on Tuesday filed a friend-of-the-court brief that argues there is no evidence to suggest Congress intended to limit the subsidies to individuals who purchased coverage through state exchanges, the Washington Times reports (Howell, Washington Times, 1/27).

The advocacy groups, which worked with the Obama administration to shape the law, wrote that the ACA's aim was to allow all U.S. residents to qualify for subsidies even if their state did not create an exchange. In a statement, the groups wrote, "Our organizations would have strenuously objected to any suggestion that the physical and financial health of patients with serious diseases should depend on the entity administering the exchange in their state."

The groups who filed the brief include the:

• American Cancer Society;
• American Diabetes Association;
• American Heart Association; and
• National Multiple Sclerosis Society (Ferris, The Hill, 1/27).