The U.S. Supreme Court, in a 6 to 3 decision, upheld the right of the federal government to provide health care insurance subsidies to people with low income in states that have chosen not to participate in the Affordable Care Act by setting up insurance "exchanges."
The decision, written by Chief Justice John Roberts, is a big political victory for the Obama administration and a big relief for people with low incomes, including many people with HIV. Lambda Legal, Gay & Lesbian Advocates & Defenders, the National Center for Lesbian Rights joined briefs to the court urging it to uphold the subsidies.
The Supreme Court did not rule today on whether states can ban same-sex couples from marrying, but it is scheduled to release more opinions tomorrow and Monday.
The decision, King v. Burwell, upheld a decision from the Fourth Circuit U.S. Court of Appeals that said the federal government's subsidies to people with low incomes in all 50 states was consistent with the intent Congress had in passing the Affordable Care Act (ACA).
Lambda, Gay & Lesbian Advocates & Defenders, and other LGBT groups filed a brief urging the Supreme Court to uphold the lower court decision. The brief led by Lambda said that withholding the subsidies from people in the states that did not participate in ACA would "lead to an absurd and catastrophic public health result, especially in the context of HIV…."
Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, and Elena Kagan joined the Chief Justice in the majority opinion.
Justice Antonin Scalia wrote the dissent, which was joined by Justices Clarence Thomas and Samuel Alito.
President Obama signed the Affordable Care Act into law in 2010 with the aim of providing health care insurance for all citizens. One aspect of the law required states to create health insurance "exchanges" through which citizens could do comparative shopping and find coverage they could afford. If states decided against creating their own exchange, the law provided for the federal government to set up an exchange for citizens in those states.
The ACA also provided for the federal government to provide subsidies for citizens with low incomes through the exchanges. Opponents of the ACA challenged those subsidies, saying the law meant them to be provided only through state-established exchanges, not through federal exchanges. A conflict arose over the law's stipulation that the subsidy depended in part on whether the "applicable taxpayer" sought insurance through "an Exchange established by the state…." In writing the regulations to implement the ACA, the Internal Revenue Service said the subsidies were available to a taxpayer who enrolled through "an Exchange," whether it was established by the state or the federal government.
The majority said "State Exchanges and Federal Exchanges are equivalent…."
"If a State chooses not to follow the directive in [the ACA] that it establish an Exchange, the Act tells the Secretary [of Health and Human Services] to establish 'such Exchange.' And by using the words 'such Exchange,' the Act indicates that State and Federal Exchanges should be the same," wrote Chief Justice Roberts.
Justice Scalia called that conclusion "absurd" because "The Secretary of Health and Human Services is not a State."
Scott Schoettes, HIV Project Director for Lambda, called the majority decision "great news," saying it protects "access for all" to health insurance, "including people living with HIV who are low-income, rural, southern, Black, and were—before the Affordable Care Act—largely uninsured."
"No one should be put at greater risk to the ravages of HIV simply because they live in one of the 34 states choosing not to set up its own health insurance exchange," said Schoettes. Lambda noted that, when ACA was enacted in 2010, "only 17 percent of people living with HIV had private health insurance." Schoettes said that, while Lambda doesn't have statistics on the change since ACA, "we know that it has increased substantially, because we know that there are lots of people enrolled through the exchanges today that were not previously able to obtain private health insurance."
The brief noted that the rate of uninsured LGBT adults with low income went down by eight percentage points during the first year of ACA enrollment.
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Press release from Lambda Legal
( New York, NY June 25, 2015 ) — Today, in a 6-3 decision in King v. Burwell, the United States Supreme Court, rejected the latest challenge to the Patient Protection and Affordable Care Act ( ACA ), declaring that health insurance subsidies are available to residents of all states.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them[,]" the Court stated in the opinion authored by Chief Justice Roberts. "[The tax] credits are necessary for the Federal Exchanges to function like their State Exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid."
"This is great news. The majority ruled to preserve the tax credits and maintain the integrity of the Affordable Care Act, protecting access for all, including people living with HIV who are low-income, rural, southern, Black, and were—before the Affordable Care Act—largely uninsured. No one should be put at greater risk to the ravages of HIV simply because they live in one of the 34 states choosing not to set up its own health insurance exchange," said Scott Schoettes, HIV Project Director for Lambda Legal.
"When Congress enacted the ACA in 2010, only 17% of people living with HIV had private health insurance—a disheartening statistic given the greatly improved health outcomes and dramatically reduced likelihood of transmission when people have access to consistent care. Today, the Court acted to preserve a key component in the battle against HIV/AIDS—improved access to affordable, reliable and comprehensive healthcare, an especially critical need for vulnerable communities of color," Lambda Legal Counsel Greg Nevins said.
Last January, Lambda Legal filed a friend-of-the-court brief on behalf of nine national HIV advocacy organizations focusing on how an adverse decision in the case would most severely impact people of color living with HIV in the states that have elected not to run their own health insurance exchange.
The Affordable Care Act, signed by President Obama in March 2010, reformed aspects of the healthcare and insurance system and expanded access to private health insurance for millions of Americans. In King v. Burwell, opponents of the ACA—which is providing access to healthcare for millions of previously-uninsured Americans—attempted to eliminate tax credits that make health insurance affordable for most low-income residents in the 34 states that have a federally-facilitated health insurance exchange, including tens of thousands of people living with HIV. The lawsuit jeopardized access for those earning between 100%-400% of the Federal Poverty Level ( $23,850-$95,400 for a family of four ) to the subsidies that allow them to afford health insurance and maintain their health. The IRS ruled that the tax credits are available to participants on the health insurance exchanges in every state, but the challengers wanted to limit the tax credits only to residents of states that established and are administering their own health insurance exchanges.
The following organizations joined Lambda Legal as signatories in the amicus brief: Asian and Pacific-Islander Coalition on HIV/AIDS ( APICHA ), Black AIDS Institute, Gay and Lesbian Advocates & Defenders ( GLAD ), GLMA: Health Professionals Advancing LGBT Equality ( GLMA ), HIV Prevention Justice Alliance ( HIV PJA ), Latino Commission on AIDS, National AIDS Education and Services for Minorities ( NAESM ), National Black Justice Coalition ( NBJC ), and National Minority AIDS Council ( NMAC ).
Lambda Legal Counsel Greg Nevins and HIV Project Director Scott Schoettes joined Kristen Mayer, Nicole Cate, Douglas Hallward-Driemeier and Nicholas Perros of Ropes & Gray LLP as counsel on the brief.
Read the brief www.lambdalegal.org/in-court/legal-docs/king_us_20150128_amicus-lambda-legal-et-al .
The case is King v. Burwell.
Press release from AIDS Foundation of Chicago
Today, the United States Supreme Court ruled to allow the continuation of federal subsidies through the Affordable Care Act ( ACA ) to help people across the U.S. afford health insurance. The landmark case of King v. Burwell was decided on a vote of 6-3, with Chief Justice John Roberts writing the majority opinion. The AIDS Foundation of Chicago ( AFC ) is elated that the court has ruled to continue these subsidies that have allowed millions of Americans to afford health insurance — many for the first time.
"This ruling is an enormous victory for people in Illinois who rely on these subsidies to access health insurance, including thousands of people living with HIV or who are vulnerable to HIV," says John Peller, president/CEO of AFC. "The ACA's core assertion that health care is a right and not a privilege was put to test before the court, and I join in with the millions of Americans who today can breathe easy knowing that that right has not been diminished."
"This ruling ensures that health insurance subsidies provided to low- and middle-income people in 34 states will continue," says Daniel Frey, AFC's director of government relations. "Thanks to subsidies, thousands of people with HIV in Illinois and tens of thousands across the country will be able to continue to access more affordable, comprehensive health care to better manage their HIV and other conditions. There is no question that the ACA has been a once-in-a-lifetime game-changer for the fight against HIV. Thanks to the Supreme Court's ruling, that fight can continue uninterrupted."
AFC has leadership staff and community advocates available for interviews to speak about the impact of this court ruling on people living with and vulnerable to HIV in IL.
