NEXT week, on March 4, the Supreme Court will begin hearing arguments on the controversial issue of health insurance tax credits detailed in King v. Burwell, a case dealing with problems surrounding the current Affordable Care Act (ACA). The long-term effects of the case would include raising the prices of health insurance for more than 6 million people in almost 40 states.
“This case goes to the very heart of the Affordable Care Act (ACA) and its effects cannot be understated,” said senior policy analyst Iyanrick John from the Asian & Pacific Islander American Health Forum (APIAHF), the oldest and largest health advocacy organization working with Asian American, Native Hawaiian and Pacific Islander communities across the nation. “The majority of people getting coverage are doing so with the help of tax credits through the federal Marketplace.”
Currently, only 16 states rely on their own state-run insurance exchange (California, which has its own Covered California market, is one of them). In King v. Burwell, the Supreme Court will consider the question of whether tax credits from the ACA are limited only to state-run marketplaces, or if they should be given to all.
The conservative plaintiffs challenging the current law argue that the way it is written does not allow ACA tax credits to go to people whose states have not chosen to set up their own health care marketplaces—many for federal funding reasons, creating less of an incentive to. Meanwhile, the Obama administration argues the ACA writers clearly intended for people in all 50 states to get the tax subsidies, whether or not they live in a state with a self-run marketplace.
“With the current makeup of Congress,” John commented, “it is unlikely that fixing the ACA is a top priority for them. They don’t have a strategy.”
The case has a big impact on the Asian American community, especially in federally-funded states like Texas, New Jersey, and Florida, who have the largest uninsured and ACA-eligible Asian American and Pacific Islander populations.
“If the Supreme Court takes away tax credits for [federal marketplace] states, this will have a major ripple effect throughout the entire insurance marketplace—including skyrocketing premiums and people losing/dropping out of their insurance,” said John, in a press briefing with the APIAHF. “Doing this would erode coverage expansions, especially for the Asian-Pacific Islander community.”
Furthermore, John added, removing tax credits in these states could likely increase health insurances costs overall, including costs for coverage in state-run markets.
“11 percent of our community lives below the federal poverty line,” said Doreena Wong, project director for the Health Access Project at Asian Americans Advancing Justice – LA. “Even worse, according to many studies AAPIs are more likely to develop serious conditions like hepatitis, stomach or liver cancer. Much of our community is impacted by these disparities.”
“Having tax credit would reduce these disparities by expanding access for coverage that many low-income families cannot afford,” Wong continued. “If these credits are taken away, that means less people will have to have coverage as required by the government. It’s an adverse selection that will send the insurance market into a death spiral.”
Action for Health Justice, an initiative comprised of the APIAHF, the Association of Asian Pacific Community Health Organizations, and Asian Americans Advancing Justice, jointly filed an amicus (“friend of the court”) brief on Jan. 28, detailing stories from people who would suffer life-threatening consequences without health coverage. The 82-page brief highlights the importance of the ACA’s tax credits in helping people get access to that care. Prior to the law, nearly one in seven APIs were uninsured and even more were under-insured—the ACA remedied that by substantially expanding its access to health insurance for middle- and low-income communities through tax credits, making health coverage more affordable.
“The subsidies in section 36B of the Internal Revenue Code are a key component of Congress’s plan to reduce the number of uninsured Americans. Testimony of numerous individuals show that these subsidies have enabled millions of previously uninsured or uninsurable individuals of all races and in all states to obtain and afford the health care that they need. This is particularly true for many low-income individuals—especially for those living in states without the Medicaid expansion—whose only affordable option is to purchase health coverage without subsidies. Thus, subsidies have helped achieve Congress’s goal of ensuring that every American has access to quality health care,” the brief reads.
“This case has dire consequences for the health of AAs and NHPIs nationwide, not just in the states subject to the lawsuit,” said Wong, a member of Action for Health Justice. “A bad decision from the Court would result in many individuals making difficult choices that no one should have to face, such as foregoing treatment for serious health conditions or skipping meals to pay for doctor’s visits.”
Kathy Ko Chin, APIAHF President and CEO, shared an example of an elderly Korean-American pastor from New Jersey, Sam Hyun H., who would not be able to afford coverage without the ACA’s tax credits, and would be forced to skip treatment—a dangerous move for someone recovering from a heart attack and heart surgery.
“Congress’ specific intent is to increase health coverage,” said Wong. “Taking away tax credits would subvert the whole core purposes of the Affordable Care Act—as many as 13 million could lose their health insurance. The human cost would be tremendous.”
The final decision of the King v. Burwell ruling is expected in June.
The White House has not announced any kind of contingency plan for the current law, and Congress (which has uniformly opposed President Barack Obama’s health care law as a whole) has not attempted to change its language. Instead, Republicans are planning to use the ruling against the administration in the case to force Obama to make wholesale changes to the ACA.
(With reports from Asian & Pacific Islander American Health Forum, Obamacare Facts, NBC News)
(www.asianjournal.com)
(LA Midweek February 25-27, 2015 Sec. A pg.1)
