US Supreme Court will hear challenge to Obamacare subsidies

BMJ 2014; 349 doi: (Published 10 November 2014) Cite this as: BMJ 2014;349:g6730
  1. Michael McCarthy
  1. 1Seattle

In a surprising ruling, the US Supreme Court announced on Friday 7 November that it would hear a lawsuit filed by opponents of the Affordable Care Act that attacks a key element of the 2010 health reform law.

If successful the lawsuit would gut the law by blocking about $36bn (£22.6bn; €28.8bn) in subsidies to 7.3 million low income people who are projected to purchase health insurance on exchanges run by the federal government by 2016.1 2 In the King v Burwell lawsuit the plaintiffs note that the law authorizes the Internal Revenue Service to provide subsidies for plans that are “enrolled in through an exchange established by the state” but that it makes no mention of exchanges run by the federal government.

When the law was passed it was generally assumed that each state would set up its own exchange. However, about three dozen states …

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