The Supreme Court's decision in the King v. Burwell decision is a victory for the millions of Americans who need financial assistance to afford health insurance coverage. As a result of the 6-3 ruling, nearly 6.4 million Americans who receive subsidies to purchase health care plans through healthcare.gov, the federal government's health insurance marketplace (or exchange), can continue to receive financial help to get the care that they need. The subsidies are helping to close the gap in health care coverage among low-income and minority communities and are critically important for addressing health disparities.
The latest challenge to the Affordable Care Act heard by the high court questioned the legality of the subsidies provided through state exchanges set up by the federal government. Largely due to the strong opposition to the ACA by Republican leaders, nearly three dozen states decided not to run their own exchanges. Consequently, the Obama administration established marketplaces for these states on healthcare.gov.
According to an amicus brief filed by the American Public Health Association and deans and faculty of some of the leading schools of public health, 64% of the U.S. population lives in the 34 states with federally-facilitated exchanges. Two-thirds of residents in those states have family incomes between 100% and 400% of the poverty level and are therefore eligible for subsidies.
As of April 2014, nearly 90% of all recipients of premium tax subsidies offered through the exchanges live in these states. The majority of uninsured and low-to-moderate income African Americans and Hispanics live in states with federally-facilitated exchanges and would have been adversely affected if subsidies were no longer available through healthcare.gov. Compared to states that established their own exchanges, poverty rates in the 34 states with federally facilitated exchanges are higher and residents are more likely to experience health disparities (e.g. infant mortality, diabetes, and deaths from heart disease and cancer) associated with access to preventive and regular health care.
The plaintiffs in the case argued that language in the ACA allows subsidies to be provided only to low and moderate income adults who purchase health plans through exchanges established by the states. In refuting the plaintiffs' claims, the Obama administration argued that the law provides it with the authority to make subsidies available in both state and federally operated exchanges. The Supreme Court affirmed the federal government's interpretation, thus securing continued access to government subsidies for individuals and families that would otherwise be unable to obtain health care coverage.
King v. Burwell is part of a sustained effort to undermine the ACA by conservative opponents. For those who care about reducing health disparities affecting communities of color, every successful attempt to chip at the ACA likely means fewer opportunities for communities with the most need to obtain health care coverage. While coverage does not guarantee access, it is an important first step on the path to ensuring that everyone has access to quality care regardless of their race, ethnic background or socioeconomic status.