King v. Burwell Decision Could Disrupt Entire Health Insurance System

With just a couple of weeks left in the Supreme Court’s session, a decision in King v. Burwell is expected before the month ends. King v. Burwell focuses on the premium tax credits that make health care affordable to low and middle income individuals who gain insurance through the health insurance marketplaces established by the Affordable Care Act. The plaintiffs in the lawsuit claim that the Affordable Care Act only allows people to receive premium tax credits in states that run their own health insurance marketplace, as opposed to the states who use the federally-facilitated Marketplace. If the majority of the justices agree with this argument, their decision could throw the health insurance system into chaos. A ruling in the plaintiff’s favor would result in millions of people losing their health insurance because they would no longer afford their insurance on the exchanges. In the last open enrollment period, around 7.5 million people received premium tax credits in states that used the federally facilitated exchange. This loss of health insurance will have real impact: an amicus brief filed by a public health scholars and the American Public Health Association predicts that an additional 9,800 Americans will die each year if the Court rules in the plaintiffs’ favor. These statistics are not just the result of people losing their premium tax credits but also the collapse that would ensue resulting in the likely collapse of many federally-run state exchanges. Under a “death spiral,” healthy individuals will drop out of the exchanges because they will no longer be able to afford the health plans without subsidies, resulting in higher premiums for the relatively unhealthier individuals who continue to purchase insurance through the exchanges. A government-funded study found that without the subsidies, premiums will rise by 43.3% and enrollment will decline by 68%. The Reform Movement has long advocated for a system in which health insurance is available to all, and a ruling in the plaintiff’s favor would severely undermine the accessibility and affordability of health insurance. With this in mind, the Union for Reform Judaism, the Central Conference of American Rabbis and Women of Reform Judaism joined an amicus brief filed by the National Women’s Law Center defending the subsidies and emphasizing the significant negative impact a ruling in favor of the petitioners would have on women, as a major purpose of the Affordable Care Act was to eliminate health care practices that discriminated against and disadvantaged women. Furthermore, the URJ, WRJ and NFTY joined ten other national organizations in a public statement supporting affordable access to health care and rejecting the challenge in King v. Burwell, and Barbara Weinstein, Associate Director of the Religious Action Center of Reform Judaism, wrote an op-ed in the Washington Jewish Week explaining that upholding the Affordable Care Act subsidies is both a moral and legal necessity. The views laid out in amicus brief and public statement reflect our long history of not just supporting health care reform and health insurance, but the Jewish community’s historic commitment to affordable health care. Maimonides, a revered Jewish scholar, listed health care first on his list of the ten most important communal services that a city had to offer to its residents (Mishneh Torah, Hilchot De’ot IV: 23). To read more about the oral arguments, check out SCOTUSBlog’s coverage of the case. To learn more about Jewish values and health care, visit the RAC’s webpage on health care.