It’s worrisome that the U.S. Supreme Court would even take up King v. Burwell, a baldly political case that is the latest attempt to cripple the Affordable Care Act. What’s worse, a poor decision by the court next spring would put the fate of the law in the hands of some of its biggest opponents, including Maine Gov. Paul LePage, risking the health of millions of Americans who already have benefited from subsidized health insurance.


When the ACA went into effect, states were given the choice of establishing their own health-insurance exchanges, also known as marketplaces, or using a federally operated exchange. At issue in King v. Burwell is one line in the 900-page law that says subsidies for health insurance plans are available only to people who are enrolled in a plan purchased “through an Exchange established by the State.”

Though federal and state exchanges are clearly equated throughout the rest of the law, and though it was clearly the intent of the law to offer subsidies through both, opponents of the ACA are seizing upon that one line to argue that subsidies should be allowed only through the 14 state-run exchanges, not in the federal exchange that serves the rest.

It is unusual that the Supreme Court would take this case now, when there is no conflict to sort out between lower court decisions. The case centers on what amounts to a typo in a massive document, one that could be cleared up quickly and easily by a Congress less gridlocked by partisanship. It is not a constitutional dispute that warrants the use of the court’s limited time.


But with total repeal off the table as long as President Barack Obama is in office, conservatives are trying to dismantle the ACA piece by piece. Because of the interlocking nature of the law, they have been partly successful.

The ACA, for instance, does not offer subsidies to certain low-income people because they were supposed to be covered under one of the law’s other components, Medicaid expansion. But 23, mostly Republican-leaning states have refused to expand Medicaid, leaving those people without affordable coverage options.

Removing the subsidies is the next step in undermining the ACA, as it would make many of the plans offered through the federal exchange unaffordable. In Maine, where 89 percent of the more than 35,000 residents who bought plans under the ACA last year received subsidies, there would be an average increase in premiums of $344 per month.


Of course, should the court rule against subsidies, governors in the states that use the federal exchange could simply and affordably create state exchanges to keep them available. In fact, the states still could rely on the federal exchange to handle enrollment as long as they established sufficient oversight.

But many of the states that declined to create their own exchanges did so because of a philosophical and political aversion to the ACA, and they are unlikely to warm to the idea now.

“I’m not lifting a finger,” LePage said in a 2012 interview about whether Maine would create a state exchange. “We’re not going to get involved. We’re going to let Mr. Obama do a federal exchange. It’s his bill.”

It would be a shame to backtrack on the advances made thus far by the ACA. After a rough start, the law has been a modest success.

Millions more Americans have health insurance. The increases in the cost of health care have slowed, and it appears the same is happening to insurance premiums. In the states that expanded Medicaid, hospitals are seeing a decrease in budget-busting charity care. And that’s with the constant obstruction from the right.

The Affordable Care Act is not perfect; nothing that size could be, initially. But the ACA should be given a full opportunity to succeed. And if changes are necessary, they should come through negotiations between lawmakers and the White House, not politicized court cases.

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