Observations Yankee Doodling

US Supreme Court v Obamacare: round 2

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1368 (Published 11 March 2015) Cite this as: BMJ 2015;350:h1368
  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, professor of family medicine, Georgetown University, and associate editor, The BMJ
  1. dkamerow{at}aafp.org

Will the Affordable Care Act be gutted because of a small drafting error?

The US Affordable Care Act (“Obamacare”) was designed to expand health insurance coverage in three major ways: allowing young people through to age 25 to be included on their parents’ policies; expanding the Medicaid program for poor people to include those earning up to 133% of the federal poverty level; and providing federal subsidies to help low and middle income people afford mandated health insurance.

The third mechanism, subsidies, in the form of tax credits, has become the latest focal point for controversy. A little known lawyer discovered four words in the 1000 page law that cast doubt on whether the subsidies could be given to around seven million people who were already receiving them.1

Obamacare gave each state the option of setting up its own marketplace (called an exchange) to sell health insurance policies to its citizens. If the state declined, then the federal exchange—healthcare.gov—took over that state’s enrollments. Only 13 states set up their own exchanges, …

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