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“Established by the State”: The SCOTUS has spoken

The King vs Burwell decision has been long awaited. In a 6-3 overwhelming victory for the Affordable Care Act and the Obama administration, the Supreme Court has found for the continued availability of subsidies through the federal government’s health insurance exchange.

David King and a group of plaintiffs from Virginia had hoped that the Supreme Court would review the phrase “established by the state” and determine that the subsidies only be available where an individual’s state had established a health insurance exchange. These subsidies, in most cases, reduce the cost of the insurance so that it is less than 8% of household income. The ACA’s individual mandate provision states that, if health insurance coverage is less than 8% of income, then it is qualified coverage for the mandate. The King vs Burwell case said that if these subsidies were illegal in, individuals whose premiums were more than 8% of income could qualify for an exemption to the individual mandate.

Although Delaware, Pennsylvania and Arkansas have submitted plans for their own state exchanges, they won’t be required for individuals to go on receiving subsidies. Obamacare won its second SCOTUS victory.


Bottom line: the ACA is unchanged for now. The individual mandate remains intact; some will qualify for federal subsidies, some won’t, but their state of residence won’t be a factor.


For additional information, contact EAB HealthWorks.