Wait What Is Even Happening With the Affordable Care Act: A Tale of Two Rulings

The DC Court of Appeals and the 4th Circuit Court of Appeals both handed down rulings on health care subsidies yesterday with totally conflicting opinions. The 4th Circuit Court of Appeals ruled unanimously in King v. Burwell that health care subsidies should be available to all who have purchased insurance on the health care exchange, as the IRS is currently providing. The DC Court of Appeals ruled 2-1 in Halbig v. Burwell that health care subsidies should only be available to those who have purchased their plan through state exchanges and that the IRS illegally extended subsidies to those who purchased their plan through the federally run exchanges.

What does this mean for the 8 million people who have purchased healthcare coverage through the exchanges set up under the Affordable Care Act? If the DC Court of Appeals’ argument is upheld, individuals who purchased their plan through the federally run exchange will lose access to affordable health care. Because the courts came down with different rulings, this may put the issue on the fast track to a Supreme Court hearing. For now, the U.S. government is appealing the DC Court of Appeals decision to the entire 11-person appeals court. Judge Harry T. Edwards, the one dissenting vote in the D.C. case, called the ruling a “not-so-veiled attempt to gut the Patient Protection and Affordable Care Act.”

You may remember that, as of this year, all folks in the U.S. have to have health care coverage or be charged a penalty, a key provision of the ACA that was upheld by the Supreme Court in 2012. However, if an individual or family’s health care costs exceed 8% of their income, they are exempt from the fee. If the D.C. decision is upheld, it creates a loophole through which people who are currently uninsured will remain uninsured because their health care costs will skyrocket to the point that they can no longer afford them.

People in 36 states would affected by the DC ruling because their state either did not set up their own exchange or partially relies on the federal exchange. This would yank out the heart of the ACA and undo the years of tireless work that have gone into giving more folks access to affordable health care.

According to federal statistics from HHS, the average post-subsidy premium for folks enrolled in the federal exchange is 76% less than the full premium. To put that in numbers, a premium of $346/month would only cost $82/month due to subsidies. If the DC ruling becomes the law of the land, the entire $346 premium would be paid by the subscriber. Obviously, for individuals and families who are already living close to their means, this would be impossible to afford. Many would end up going without insurance coverage, as they have for months, years, lifetimes, or generations.

As ya’ll know, this would disproportionately affect lots of folks who disproportionately lack access to health care, including LGBT people. I don’t have to tell you how shitty health disparities for LGBT people are. The ACA was kind of awesome for LGBT people. It established that being transgender could not be used as a pre-existing condition to deny coverage and that transgender people would be guaranteed coverage regardless of gender identity or expression. It also explicitly included non-discrimination language that protected LGB individuals, LGBT married couples, and LGBT families with kids. According to the Center for American Progress, more than 500,000 LGBT people are eligible for health care subsidies through the federal exchange across the U.S.

Who else will be affected? If you said people of color, women, and young people, you’d be right! According to the HHS, of the more tan 8 million people who have enrolled in the health care exchanges:

  • 54% are female,
  • 34% are under age thirty-five,
  • 37% are people of color.

The ACA may not be perfect, but it is giving millions of people access to health care security and putting the brakes on out-of-control health care costs and discriminatory policies. White House press spokesperson, Josh Earnest, announced at a press conference that they are “confident in their legal position… rooted in the fact that it is pretty obvious [Congress’s] intent was for every eligible American who applied for tax credits to make their health care more affordable to have access to those tax credits.” Let’s hope he’s right. For the sake of all our communities and families, this core piece of the ACA must be preserved.

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KaeLyn is a 40-year-old hard femme bisexual dino mom. You can typically find her binge-watching TV, standing somewhere with a mic or a sign in her hand, over-caffeinating herself, or just generally doing too many things at once. She lives in Upstate NY with her spouse, a baby T. rex, a scaredy cat, an elderly betta fish, and two rascally rabbits. You can buy her debut book, Girls Resist! A Guide to Activism, Leadership, and Starting a Revolution if you want to, if you feel like it, if that's a thing that interests you or whatever.

KaeLyn has written 230 articles for us.


    • I KNOW. Because conservatives and Republicans don’t want to see health care reform work, and they don’t care that the expense is millions of people’s health and lives. Ugh.

  1. I live in Maine and I am so screwed. The state slashed Medicaid rolls before the ACA even went into effect. When I applied through the Federal Exchange I also applied for Medicaid and was turned down. I got a hefty subsidy, which brought the monthly cost of my premium down from $850+ to $228, an absolute godsend. But on June 1 my income fell by 50%. With a little juggling of the numbers, I was able to keep my coverage – but I can’t afford to pay 25% of my income for health insurance. And I still can’t get Medicaid! I have cancer (3rd time), diabetes, and a cluster of arthritic diseases, as well as being bipolar, and I need health insurance. I sure as hell can’t afford to pay my costs out of pocket! Even without losing my subsidy, it’s looking really grim.

    • I am really feeling for you. I hope the White House is right that the subsidies will be protected, but I know that’s still not enough for many folks. The ACA definitely isn’t the be all-end all. For many of us who were really fighting for single payer or (gasp) universal health care, it still falls short. $228 is still a lot. You probably already know this, but if you have had a life change (like a change in income), you may qualify for an increased subsidy. Sending you love.

      • With the newly recalculated subsidity it’s down to … wait for it! … $209. Time to re-re-apply for MaineCare. Wheeee!

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