SCOTUS, ACA, King v Burwell ...Here we go again...

This week, on Wednesday, the Supreme Court is to consider the case known as King v. Burwell — a challenge to that part of the Affordable Care Act (aka Obamacare & ACA) which deals with subsidies.

The ACA created a subsidy system for low and some middle income families to help in the purchase of health insurance through insurance exchanges "established by the state". The law sets a cap on the amount of insurance premium that individuals and families will have to pay for the second cheapest Silver plan based upon that person/family's income in relation to the Federal Poverty Level.

States were given the option of establishing their own exchanges or allowing the Health and Human Services Department to run a state marketplace for them. The administration would argue that both types of exchange count as having been "established by the state" (i.e. a state with a federally run exchange having made their choice to "establish" that exchange in their state.) Lawyers will argue day and night on this point, I dare say!

The case turns, I think, on just those four words of the Act: "established by the state".

Plaintiffs attest that subsidies should be available only to people buying coverage on exchanges “established by the state,” i.e. state-run marketplaces. 34 states don’t have their own exchanges. Residents rely on federally run marketplaces - the course opted for by their state representatives. If the court rules in favor of the plaintiffs, subsidies in the form of tax credits would end in those 34 states. Subsidies have made insurance affordable for millions of people who would otherwise have remained uninsured.

The whole point of ACA was to make health care affordable to everybody, not simply to those in states where the state had opted to run their own exchange. If this had not been so, wording would have been clear on this point (or ought to have been!)

There's a somewhat dodgy argument by some lawyers that proposes the real reason for not making the subsidy available in relation to both types of exchange was a way of forcing reluctant states to get on board and establish their own exchanges - or lose availability of subsidies for residents of their state. I can easily imagine that some states would not have wished to get into the exchange/marketplace thing because of the extra worries and risks involved - so much easier to let the government deal with it all! The option and the decision on this did remain with each individual state. States' rights an' all that.

It doesn't seem likely, to me, that there was ever an intention to lock people out of subsidies depending on their type of health exchange. That would have been counterproductive. The aim was to bring in as many insured people as possible, to make the system work as intended.

If SCOTUS finds for the plaintiffs, outlaws subsidies in states with federally run exchanges, the people of those states who become unable to afford health insurance will be rightly incensed. Governors of such states should be under immediate pressure to establish state run exchanges tout de suite! Would they though? Would the people rise up and demand? Would the state representatives comply? Oh.... hmm...and could this possibly be a ploy to force states into running their own exchanges? No, that doesn't feel right....a bit conspiracy-ish for me.

I doubt that those potential eventualities will come about, unless the Justices are feeling particularly obtuse and bloody-minded, with intent to bring down the whole caboodle. Couldn't they have done that on the last opportunity - that time in 2012 when Chief Justice Roberts, for once, saved the day for ACA?(SEE HERE)

"The Lord's Work"? Hobby Lobby? Really?

During my first couple of years in the USA one of my favourite places to look around, when out shopping, was the Hobby Lobby store in a nearby city. Over recent years I've become disenchanted with the store. Their merchandise has seemed increasingly shoddy, over-priced and less imaginative than it once was - and now almost all of it is made in Chinese sweatshops. We now make a point of looking for alternative outlets when in search of art materials, decor, frames, holiday items etc.

Now I read that Hobby Lobby - (for any passing reader unaware of this company, it's a privately held retail chain of arts and crafts and general decor stores based in Oklahoma City) is bringing a lawsuit against the "contraceptive mandate" i.e. health insurance coverage for employees that covers emergency contraceptives (morning after pill and anything similar). Hobby Lobby has some 13,600 employees in 41 states.

The lawsuit, against U.S. Health and Human Services Secretary Kathleen Sebelius regarding The Affordable Care Act, opposes the mandate that a wide range of preventative health-care services, including birth control, be offered to women without out-of-pocket expenses. The suit lists Hobby Lobby, Mardel Inc. and family members of company founder David Green as the plaintiffs. Plaintiffs state that requirements of the Act would violate their religious beliefs. CEO David Green has said "We simply cannot abandon our religious beliefs to comply with this mandate. Hobby Lobby has always been a tool of the Lord's work, but now our faith is being challenged by the federal government."

I'll be very interested to discover how this lawsuit is eventually resolved.

My own views, for what they're worth, are that, whether or not one agrees with a law of the land, it remains the law and must be adhered to. Religious proclivities are not involved in the laws of the USA, as I understand it, other than the fact that freedom of religion is protected by the Constitution. Freedom of religion means exactly what it says. CEOs such as Mr Green who profess to being good Christians can lead their lives in whatever way they wish, within the laws of the land. So can everyone else, whether of Christian belief or any other belief, or of no belief at all.

The Affordable Care Act outlined what should be included as part of a health insurance plan. An American for profit company is obligated to follow US law.

Employees of Hobby Lobby, or those employees covered by the company's health insurance scheme - which might well be a small proportion considering the number of part-time employees - take up employment with the company agreeing to the level of pay, which has embedded within it healthcare insurance coverage. That is part of what they are paid in return for their daily work in making profits for the company. The insurance coverage is not something benignly bestowed upon them by their employer - it's part of their wage for the work they do. As such it does not include the right of the employers to make medical-related decisions for their employees.

The employers would not, in any case, be "paying for the morning after pill", the main thorn in Mr. Green's side (or so he proclaims), the insurance company would be paying for it. The employer pays, as part of the full-time employees' recompense for the work they do, to have their medical needs covered; involvement in employees' healthcare stops right there - any further meddling could be seen as discrimination.

As a side issue: why, if Mr Green and his family are against supporting anything related, however vaguely, to abortion, and are intent in "doing the Lord's work" does their company sell so much merchandise made in China? Over 13 million abortions a year are carried out in China, including both forced and elective operations. Of course to take that into account would mean a hefty drop in profits for Hobby Lobby - wouldn't it? In China and other third-world countries from which his company's merchandise comes, people have little resembling human rights. Merchandise sold by Hobby Lobby stores is manufactured in "sweat shop" conditions. The company makes vast profit from the work of those paid a pittance and working in terrible conditions. Which Christian priciple is Mr Green and Co. following when deciding the source of their merchandise?