by Sara Rosenbaum, Harold and Jane Hirsh Professor, Milken Institute School of Public Health, The George Washington University and Georges Benjamin, executive director, American Public Health Association
King v Burwell carries profound public health implications.
The central legal question in this case is whether the Internal Revenue Service properly interprets 26 U.S.C. 36B to make the federal premium tax credits of the Affordable Care Act (ACA) available to all eligible taxpayers through the Exchanges in every state. It is evident from the government’s brief as well as briefs filed by leading economists, who argue the ACA cannot function without premium subsidies and insurers, who argue that broad risk pools are an essential component of the ACA and therefore must have been required for every state regardless of who runs the exchange that a Supreme Court decision in favor of the petitioners in King v. Burwell could unravel the industry in dozens of states rather than strengthen it, as the ACA was structured to do.
But the harms flowing from a decision against the government transcend a crisis in the insurance markets: by stripping residents of subsidies in the 34 states that depend on the federal Exchange, a decision against the government would carry enormous implications for public health. For this reason, over 100 public health deans and scholars joined the American Public Health Association to file an amicus brief on behalf of the government, arguing in favor of a ruling that would uphold access to affordable insurance for nearly all Americans, regardless of the state in which they live.