In a case before the U.S. Court of Appeals for the District of Columbia Circuit, a group of small business owners argued that the law authorizes subsidies only for people who buy insurance on exchanges established by the states.
The ruling, which will likely be appealed by the Obama administration, meshes with ongoing Republican attempts to cripple or repeal the landmark law that the president signed in 2010 in a campaign to dramatically reduce the number of Americans who are uninsured because the high cost of coverage. The law also mandated that insurance companies could no longer deny coverage to people who already have medical conditions or drop coverage when a person became ill.
Republicans believe the law is too intrusive into the lives of Americans in that it forces then to buy health insurance or pay a penalty.
The White House said health subsidies would continue to flow for the time being. Presidential spokesman Josh Earnest said the court ruling, while it continues working through the system, has "no practical impact" on tax credits for those who used the federal rather than state systems.
The divided appeals court that sits in the nation's capital ruled 2-1 on a case that could mean premium increases for more than half the 8 million Americans who have purchased taxpayer-subsidized coverage under the law. The ruling affects consumers who bought coverage in the 36 states served by the federal insurance marketplace, or exchange. It would not affect those who bought coverage under state-run insurance exchanges.
The majority opinion concluded that the law, as written, "unambiguously" restricts subsides to consumers in exchanges established by a state. That would invalidate an Internal Revenue Service regulation that tried to sort out confusing wording in the law by concluding that Congress intended for consumers in all 50 states to have subsidized coverage.
The health care overhaul legislation was passed when Obama's Democrats controlled both houses of Congress. But if the appeals court ruling should stand, amending the law would be nearly impossible in today's partisan climate and with Republicans in control of the House.
The issue is crucial to the success of the health law because most states have been unable or unwilling to set up their own exchanges. The inaction stems in many instances from opposition by Republican governors to the Affordable Care Act.
The small business owners filing the lawsuit say the tax credits enacted by Congress were intended to encourage states to set up their own health benefit exchanges and that the penalty for not doing so was withdrawal of tax credits for lower-income residents.
Supporters of the act say the purpose of the tax credit was not to promote the establishment of state exchanges, but rather to achieve Congress's fundamental purpose of making insurance affordable for all Americans.
The case revolves around four words in the Affordable Care Act, which says the tax credits are available to people who enroll through an exchange "established by the state."
The challengers to the law say a literal reading of that language invalidates the tax agency subsidy to people in the federal exchanges. The opponents say that people who would otherwise qualify for the tax credits should be denied that benefit if they buy insurance on a federally facilitated exchange.
"It is implausible to believe that Congress gave the IRS discretion to authorize $150 billion per year in federal spending, particularly when Congress had directly spoken to this issue," the challengers to the tax subsidy said in a court filing. "Major economic decisions like these — indeed, any decisions granting tax credits — must be made unambiguously by Congress itself."
The Obama administration and congressional and state legislative supporters of the Affordable Care Act say the challengers are failing to consider the words of the statute in its entirety.
"Congress did not provide that the tax credits would only be available to citizens whose states set up their own exchanges," says an appeals court filing by congressional and state legislative supporters of the Affordable Care Act. Congressional lawmakers and state legislators supporting the act said that limiting the subsidies to state exchanges could destabilize important aspects of the law, such as the individual mandate requiring most people to buy insurance.
A lower court had ruled that the law's text, structure, purpose, and legislative history make "clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges."
But the appeals court concluded the opposite — that the letter of the law "unambiguously restricts" the law's subsidies to policies sold through exchanges established by the state.