The U.S. Supreme Court will rule this month on King v. Burwell, a case that questions whether Congress intended to offer tax subsidies for health insurance to all income-qualified Americans or just to policy purchasers in states that set up their own ACA health insurance marketplaces. If the Supreme Court strictly interprets the ACA, it will create chaos in the insurance industry and price millions of Americans back out of health insurance…
…to which prospect Governor Dennis Daugaard shrugs:
Gov. Dennis Daugaard says it’s up to federal officials to come up with a potential solution for thousands of South Dakota residents whose insurance premiums could jump thousands of dollars a year if the U.S. Supreme Court strikes down a key provision of the Affordable Care Act.
Daugaard, a Republican, said recently that he doesn’t envision a state fix to help preserve financial assistance if the high court decides to scrap insurance premium subsidies for consumers in the more than 30 states, including South Dakota, who sign up for coverage under the federal marketplace….
“We certainly don’t have the wherewithal in our budget to restore subsidies, so that’s just not even a practical reality,” Daugaard told The Associated Press. “What will happen, I expect, is unless the federal government produces some solution to replacing the subsidies, it will revert back to pre-Obamacare conditions where people buy insurance at the marketplace rates without a subsidy if they can” [James Nord, “Daugaard: Up to Feds If Health Subsidies Go Away,” AP via NewsOK.com, 2015.06.06].
Creating a state marketplace would indeed be costly and complicated. Other states have seen operating budgets for their exchanges running around $28 million to $32 million. But consider the cost of letting ACA subsidies disappear from South Dakota. Nord reports that an adverse ruling in King v. Burwell would nix health insurance subsidies for 16,800 South Dakotans. Those policyholders get an average monthly subsidy of $229 a month. That’s $46.2 million a year coming from Uncle Sam to (1) help South Dakotans get health care and (2) stimulate our economy. Take away subsidies, and those 16,800 South Dakotans either end up paying extra thousands out of their own pockets, taking away their purchasing power for other goods and services and putting a drag on our state economy, or going without insurance, which means either going without health care, going bankrupt to get health care, or going to the emergency room and saddling hospitals and the rest of us with the cost of uncompensated care, all of which put a drag on our state economy.
Governor Daugaard keeps saying we can’t afford to help South Dakotans get health insurance. I’d say we can’t afford not to help.
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Ron Pollack of the Health Affairs blog says there is “ample reason” to believe the Supreme Court will preserve the health insurance subsidies:
Abundant precedents in past Court decisions make clear that statutory interpretation requires an examination of the whole statute and its context to review meaning, rather than a blinkered focus on only a few words (see note). If the Court follows these clear precedents, it will find that an interpretation of the Affordable Care Act (ACA) that withdraws premium subsidies is contradictory to the law Congress crafted [Ron Pollack, “GOP King v. Burwell ‘Fixes’ Not Fixes at All, Would Make Health Care Worse,” Health Affairs, 2015.06.05].
To support this hope, Pollack cites Justice Antonin Scalia:
See Antonin Scalia & Bryan Garner, Reading Law: The Interpretation of Legal Texts, page 63 (2012). As Justice Scalia indicates in his treatise, in interpreting a statute, courts must choose a textually permissible reading that furthers the evident purpose of the law over one that obstructs the statutory purpose. This well-worn canon of construction “flows inevitably from the facts that (1) interpretation always depends on context, (2) context always includes evident purpose, and (3) evident purpose always includes effectiveness” [Pollack, 2015.06.05].
Governor Daugaard makes his decisions in the context of corporate colonialism and Republican wealth hoarding. His evident purpose is to ensure that the working class is held under ever-greater restraints. And the last thing he wants is an effective Affordable Care Act that withstands the test of time and litigation and proves his party’s propaganda wrong.
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But on the other side, have fun reading the libertarian Cato Institute’s busting of seven alleged myths about King v. Burwell.