|By Daniel Chang and Nick Madigan, The Miami Herald|
|McClatchy-Tribune Information Services|
The rulings put in limbo an estimated 7 million Americans in 34 states who signed up for a plan using the federally run exchange at healthcare.gov, including about a million Floridians, the great majority of whom qualified to receive financial aid from the government.
At issue is the wording versus the spirit of the landmark health law. The text states that subsidies are only available for plans bought "through an exchange established by the state,'' which applies only to 16 states and the
The remaining 34 states, including
"There's uncertainty,'' said
The Obama administration also may decide to seek a full-panel review of the D.C. court's decision, or file an appeal.
Given the opposing rulings, legal experts said, little is likely to change in the near term for the millions of Americans who bought their health plans on the federally run exchange and receive financial aid.
But there is pressure for the courts to resolve the question in the coming months, or risk a chaotic environment when open enrollment for the federally run exchanges begins on
Barlament called the decision by the D.C. court a "large threat to the effectiveness'' of the ACA.
"It's really a recipe for chaos,'' he said.
The government has paid subsidies to insurers selling health plans on the federally run exchange since the beginning of the year, based on a 2012 interpretation of the health law by the
But that interpretation was effectively overturned on Tuesday by the
Those subsidies are based on a sliding scale of income, and they're intended to help consumers pay their monthly premiums and out-of-pocket costs, such as deductibles and co-pays.
Two hours after the
Those are not the only lawsuits challenging the legality of subsidies offered through the federal exchange. State officials in
With so much uncertainty, advocates and opponents of the health law interpreted the split rulings in different ways.
"Anyone who has received a subsidy at all on the federal exchange could potentially be faced with having to make back payments, all due to
But U.S. Rep.
"People should not be penalized when their governors and legislatures refuse to set up state-run exchanges,'' she said in a written statement. "If the D.C. court's ruling were final it would create a horrible, disparate system of haves and have nots in
Advocates of the health law expressed confidence that the status quo for federal subsidies would stand.
"Today isn't different than yesterday and the next couple of days, which is that those subsidies aren't going anywhere,'' said
Duran said his group would continue to urge consumers, particularly those who can still enroll because they have recently lost a job or become parents, to apply through the exchanges.
"What we're not having,'' he said, "is a shutdown of the marketplace.''
In fact, health policy experts said it's important to remember that many elements of the health law would not be affected by the recent court rulings.
Insurers would still be banned from rejecting consumers based on pre-existing conditions, for instance, and parents could still include their children up to age 26 on health plans.
But if the judicial system upholds the D.C. court's recent ruling, then the 34 states that rely on the federally run exchange will have to decide whether to establish their own, state-run exchanges to comply with the letter of the law.
Exchange consumers are not the only potential losers if the D.C. court's ruling is upheld.
Health policy experts cautioned that the ruling could have repercussions through the healthcare system: If consumers must pay full freight for their health insurance, then fewer Americans are likely to get coverage -- and those who do will need health care the most.
"They'll drive up costs for insurers,'' said Ullmann of the
"Everyone will have to go back to the drawing board,'' Hay said. "You can't have something as important as this with multiple interpretations of what the federal obligations are.''
But Ullmann also offered a bit of historical perspective, which shows that landmark laws often change over time.
"If you look at
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