King v. Burwell challenged the legality of tax subsidies provided through the Affordable Care Act (ACA) to states with exchanges run by the federal government. A ruling in favor of the plaintiffs would have ended subsidies for those purchasing insurance in the 34 states with federal exchanges – unless those states took swift action to set up their own exchange.
The authors of the ACA sought to construct a stable insurance market in states by including the requirement that all individuals purchase insurance and by making premiums more affordable for low and middle-income Americans through the availability of federal subsidies. This structure was central to making the ACA workable at the state-level.
While a pro-plaintiff ruling would not have directly impacted California, the resulting changes at the federal level could have destabilized healthcare reform at the national level and brought unwelcome changes that would make it harder for the ACA to succeed over the long term. Regardless of the outcome, we were prepared to do everything we could to continue to fulfill our mission of increasing access to high-quality care at an affordable price.
While the ruling in King v. Burwell maintains the foundation of health reform, a solid foundation is just that – a foundation. There is a lot of work to do to make meaningful progress in lowering the cost of care and making sure those who need access to coverage the most receive it. That means continuing innovative partnerships with providers to better serve patients, taming the high cost of specialty drugs and eliminating wasteful and unnecessary treatments.
We look forward to being a part of the future for reform.
Andy Chasin is director of public policy at Blue Shield of California.