Arit John summarizes remaining legal challenges to the ACA. A big one:
As we explained earlier this year, Halbig v. Sebelius is a case launched by conservative small business owners in states using the federal exchange. They argue that, because the Affordable Care Act only specifically mentions subsidies for exchanges “established by the state,” the federal exchange can’t grant subsidies. And if they can’t get subsidies, then the insurance becomes unaffordable, so they want the court to block the IRS from implementing the law. The government argues that, obviously, they meant for everyone to get subsidies, and the case is ignoring all the prep work the administration has done to provide subsidies in all states.
Alec MacGillis comments:
On this the two sides agree: for a court to strike down the subsidies in the federally-run exchanges as out of keeping with the text would utterly devastate the Affordable Care Act.
Expanding coverage only works if many people are buying coverage in the new exchanges, the only way large numbers will do so is if the plans are relatively affordable to them, and the way the law makes coverage affordable is by providing income-based subsidies, in the form of tax credits, to the vast majority of people buying plans on the exchanges. Since no fewer than 36 states have opted to let the federal government run the exchange for their residents, ending the subsidies for people in those exchanges would blow up the law in whole swaths of the country, if not all of it.
Drum isn’t so sure:
Would it, in fact, cripple the law? Or would we end up with Obamacare being available only to about half the country? This is a trickier question than it seems. In the non-subsidy states, a couple of things would be going on. First, a lot of the provisions of Obamacare would still be in effect: community rating, guaranteed issue, the individual mandate, etc. Having all these in place without the subsidies might be bad news for insurers, which means the insurance industry could start putting real pressure on holdout states to set up their own exchanges. Second, there would be a whole lot of people who had gotten subsidies the year before and were now having them yanked away. Taking existing benefits away generates far more passion than refusing to approve benefits in the first place, and eliminating the subsidies could end up generating irresistible public pressure to set up state exchanges in order to put them back in place. Put these two things together and you have a lot of pressure to set up state exchanges in the states that don’t have them.
The Dish 