HHS Cheers as ACA Sign-Ups Pass 9 Million Mark, but Here's the Catch: 6.2 Million Could Lose Subsidies in Court Case

Meeting enrollment goals for the Affordable Care Act proved the easy part for the HHS in 2015. The hard part will come March 4, 2015, when the US Supreme Court will hear a case that could eliminate financial subsidies for millions who signed up, putting their health coverage at risk.

The Obama Administration met its second-year goal of having 9 million Americans enrolled on state and federal exchanges under the Affordable Care Act (ACA), and it did so with time to spare, according to a report released yesterday by the US Department of Health and Human Services (HHS).

For HHS, that’s the good news. The bad news could come after March 4, 2015, when the US Supreme Court will hear arguments in King vs. Burwell and several related suits seeking to unravel a key feature of the ACA. Based on yesterday’s numbers, a ruling against the Obama Administration could do that. However, a new poll from the Kaiser Family Foundation (KFF) shows that most Americans would want Congress to fix the law if the court took subsidies away.

HHS enrollment data show that 87% of the consumers received financial subsidies while signing up for coverage in the 37 states that use HealthCare.gov. Those subsidies are the point of the challenge in the case before the high court; challengers to the law argue that its plain language precludes consumers living in states without their own exchanges from receiving financial help to pay premiums. Without that help, advocates and opponents agree, a foundation of the ACA will crumble.

Yesterday, HHS announced that 9.5 million consumers were either newly enrolled or automatically re-enrolled through January 16, 2015, including 7.1 million through HealthCare.gov and 2.4 million on exchanges set up by 14 states or the District of Columbia. That translates to 6.2 million consumers with subsidies at risk, and yesterday a coalition of large medical advocacy groups called on the Supreme Court to leave the $28 billion intact. Whatever drafting errors may exist, they said, the intent of lawmakers was clear in 2010.

The groups, which included the American Cancer Society, the American Diabetes Association, the American Heart Association, and the Multiple Sclerosis Society, said their leaders had worked closely with Congress when the ACA passed, and there was no question what the intent was. They filed an in advance of oral arguments, one of many filed in the case.

“Our organizations would have strenuously objected to any suggestion that the physical and financial health of patients with serious diseases should depend on the entity administering the exchange in their state,” the groups wrote in a statement. “We would have objected even more strongly to any legislative provision that used patients’ well-being as a bargaining chip to induce states to establish their own exchanges.”

A KFF poll, meanwhile, found that most Americans are unaware of King vs. Burwell or the possibility that financial subsidies could vanish. When asked what should happen if a court ruling took financial help away from those who need it buy insurance, 64% said that Congress should pass a law to fix the problem, while 27% said Congress should not intervene.

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Nationwide, 9.5 million consumers are signed up for Health Insurance Marketplace coverage

So Far, 7.1 million have used exchanges to get health coverage for 2015

Groups warn about King v. Burwell