Newspaper article St Louis Post-Dispatch (MO)

Meaning of 4 Words at Center of High Court Health Law Fight; 'ESTABLISHED BY THE STATE'

Newspaper article St Louis Post-Dispatch (MO)

Meaning of 4 Words at Center of High Court Health Law Fight; 'ESTABLISHED BY THE STATE'

Article excerpt

WASHINGTON * The Supreme Court hears next week a challenge to President Barack Obama's health care overhaul that hinges on just four words in the massive law that seeks to dramatically reduce the ranks of the uninsured. The argument threatens subsidies that help make insurance affordable to consumers in about three dozen states.

The lawsuit focuses on the health insurance marketplaces, or exchanges, that have been set up to allow people to find coverage if they don't get insurance through their jobs or the government. The challengers argue that the health law provides subsidies only to people who get their insurance through an exchange "established by the state." But most states have not established their own marketplaces and instead rely on the federal HealthCare.gov.

The administration says that consumers in all 50 states are eligible for subsidies and that Congress would not have passed a law that omits help for so much of the nation.

Q. Why is the eligibility for subsidies such an important part of the law?

A. Aware of failed efforts on the state level to reduce the number of uninsured, the architects of the health law included three related requirements: Insurers can't deny coverage because of "pre- existing" health conditions; almost everyone must be insured, in order to get enough healthy people into the system; and consumers who otherwise would spend too much of their paycheck on their premiums get financial help in the form of tax credits.

Q. Would Congress have distinguished between consumers based on whether they get insurance through the federal government or the states?

A. The opponents say Congress could have made such a distinction, and did. Congress wanted two things nationwide subsidies and state- run insurance exchanges. So in the challengers' view, the availability of subsidies was conditioned on states' setting up their own exchanges.

Q. Has the administration given up?

A. No. The administration says the law's own "text, structure, design and history" refute the other side's arguments. Attempting to divine the meaning of four words in isolation from the rest of massive law is foolhardy, the Justice Department says. …

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