The U.S. Supreme Court’s ruling in King v. Burwell ensures that over 60,000 Mainers, will continue to be able to afford health insurance under the Affordable Care Act (ACA), preventing their premiums from skyrocketing an average of 383%.
The Court interpreted the ACA’s purpose—to create a system in which all Americans have access to affordable health care—to mean that people living in the 34 states, including Maine, that rely on federal rather than state marketplaces to buy their health insurance will continue to get the assistance they need to purchase health plans.
Four primary provisions of the ACA ensure that every American has access to health care: the guarantee issue, community rating, individual mandate, and system of tax credits. The guarantee issue combined with the community rating requires insurers to offer coverage despite a pre-existing condition, and to do so at a reasonable cost. By themselves, these two provisions would create an incentive to postpone entering the insurance market until there’s a medical need, as one could not pay into the market while healthy but still enjoy guaranteed coverage when the insurance is inevitably needed. This adverse selection would lead to a “death spiral,” wildly driving up the price of insurance as people postponed buying insurance until sickness. The ACA prevented this with the individual mandate, the requirement that all citizens not covered by an employer or the government must purchase insurance in the private market or pay a penalty to the IRS. In 2012, the Supreme Court upheld this individual mandate constitutional in NFIB v. Sebelius.
The portion of the ACA at issue in Burwell was the law’s fourth component: the ability to receive tax credits that make purchasing insurance in the private market economically viable for those with lower income, between 100 and 400 percent of the federal poverty level. Plaintiffs in Burwell argued that tax credits are only available to those who purchase their health care plans in a state-created exchange or marketplace and not a federal one. The Court dismissed this argument, finding that the, “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 Supreme Court ruling, the second to uphold the ACA, is a clear sign that, as President Obama proclaimed after the decision: the ACA is “here to stay” and will continue to dramatically lower the number of uninsured Americans.
Despite the welcome impact of the King v. Burwell decision, Maine still remains the only state in New England to refuse to expand Medicaid. The tired politics underlying this debate need to make room for substantive reform that directly improves the lives of Mainers. Nearly twelve percent of Maine’s population remains uninsured, twice the percentage of those without coverage in Massachusetts. Expanding Medicaid would provide insurance to thousands of Mainers on the federal government’s dollar. The highest court in the land has spoken, upholding a vital part of the ACA, and Maine must follow suit, and put the well-being of its citizens ahead of partisan politics.
