The Supreme Court of the United States is perhaps the strangest institution of the American system of checks and balances. Compared to the 100 senators and 435 voting members of the House of Representatives, the nine Supreme Court justices seem ludicrously powerful. These men and women are not elected but serve life-long appointments made by whomever happened to be president at the time. All this, and they hold the highest authority over the law in this country. And soon, their ruling on the Affordable Care Act, colloquially known as Obamacare, has the potential to collapse our health care system.
Back in March, the Supreme Court heard arguments for the case of King v. Burwell. In it, the challengers argued about the subsidies, or tax credits, set up by the ACA to make health care insurance more affordable for low-income people. The real problem is that the ACA requires that all states create insurance exchanges, and if they did not the federal exchange would be made available to those state residents. The plaintiffs are from Virginia, which was one state that did not set up its own exchanges. They argued it was outside IRS authority to make these credits available for both federal and state insurance exchanges. The Supreme Court is expected to release its decision by late June.
This case is complex, confusing and seemingly unimportant, because it does not involve the major controversial overhauls of the healthcare system the ACA put in place, such as the individual mandate or guarantee of insurance for everyone. Instead, it focuses on what should be a very reasonable notion that insurance should be made affordable for low-income individuals. But this may still be too much for a conservative-leaning Supreme Court.
When considering the potential consequences, it is important to remember the Supreme Court remains the only branch of government encouraged to remain apolitical. The president makes decisions based on both the electorate that got him there and the political success of his party, and congressional representatives have the interests of their constituents and their next campaign as priorities. But the Supreme Court is different. The justices make decisions based on their interpretation of the law, ultimately with respect to the U.S. Constitution. That means the court will prioritize the writing of the law over any of its ultimate effects.
But if there were a time the court should consider practical ramifications, it would be for this case. It is certainly intellectually honest and politically pure to limit their judgment to constitutional and legal arguments, but big cases have big impacts, and the ACA case represents the biggest they have had in a while. Thirty-four states are currently at risk of losing their subsidies, including Illinois.
We cannot ignore the real-world implications of losing these subsidies. Even if you oppose the ACA, the Obama administration or even government in general, you should still support the Supreme Court ruling against the plaintiffs. The alternative could be much, much worse.
If the court rules against the subsidies provided by the ACA, all the progress made in increasing the rates of insurance and providing a more fair health care system may come to a halt. The subsidies are essential for low- and middle-income Americans to afford health insurance because some estimate the subsidies reduce their premium costs by about 75 percent. If these were not in place, about 8 million Americans would likely lose their ability to afford their insurance. This would sound the death knell for all insurance, because the system we have only works if everyone is paying into it. You can imagine that if the only ones buying insurance are the rich, elderly or already ill, then prices will necessarily have to skyrocket, not to mention the inherent risk of having more Americans uninsured.
As young Americans, the ACA deserves our support. For one, it increased the age children can remain covered under their parents insurance up to 26. This is a huge boon to recent college graduates, allowing for a precious few years of coverage until they are able to secure individual insurance through a job. Although we may be young and healthy, our enrollment into some kind of health insurance is necessary to support the system as a whole. Eventually, all of us will be at the mercy of the American health care system, and ideally it will still be intact by the time we actually need it.