Clare McAndrew


Ben D’Avanzo

On March 4, the Supreme Court will hear oral arguments in King v. Burwell. The plaintiffs in this case are challenging the federal government’s ability to provide tax credits to consumers to help offset the cost of health insurance premiums in states that have not set up their own health insurance marketplaces (also known as exchanges) under the Affordable Care Act (ACA).

The parties in this case are the government and the plaintiffs who claim that the ACA harms them. Those whose lives and livelihoods have been saved by the ACA’s premium tax credits have been left out entirely. Yet an Urban Institute study found that, if the court rules in favor of the plaintiffs, 9.3 million people could lose access to health insurance under the Affordable Care Act. Families USA has captured some of their stories in our new interactive video.

Congress intended to make tax credits available in all states

healthcareThe health reform law effectively gave states the option of either establishing their own insurance marketplace or letting the federal government ( run the marketplace for them. Those who make between 100 and 400 percent of the poverty line receive tax credits to offset the monthly premiums if they buy insurance on these exchanges. The challengers say that, because one section of the law concerning these credits refers to an “exchange established by the state,” no assistance should be available for those who obtain insurance through

The underlying arguments of the plaintiffs are deeply flawed. A reading of the entire statute and its legislative history makes clear that Congress intended to make these tax credits available in all states.

More than 30 friend-of-the-court briefs make this very argument. In one brief, the members of Congress who wrote the law say that they never intended the assistance to be limited to state-run marketplaces. In another brief, 22 states argue they were never notified that the availability of tax credits could be restricted based on the type of marketplace a state had. Were there such a restriction, the Constitution would require that they know of it,

The real issue: Millions of consumers would lose their health insurance

However, the legal arguments belie the true debate behind this case: Should millions of consumers be denied affordable health insurance? Consumers are often overlooked in the legal wrangling over King v. Burwell.

For example, Lori Z. of Rosendale, Wisconsin, is recovering from breast cancer. She is also a small business owner. Before the ACA’s premium tax credits were available, money was tight, but she still had to decline some big business orders because she was undergoing treatment. Once she became eligible for tax credits, which save her $230 in monthly premiums, she could focus on her company. Lori told us, “Having the subsidy gave me peace of mind so that I wasn’t living from paycheck to paycheck. Now I’m able to invest in my own business again.”

David Tedrow, who lives in Durham, North Carolina, is also grateful for the ACA’s premium tax credits. Without them, he wouldn’t be able to buy health insurance. David is a liver transplant survivor and, before the ACA was passed, he was in danger of losing his place on the transplant list because of the cost of insurance. He still has to pay for expensive medication.

In a column for The Washington Post, he wrote: “Bottom line, without insurance and the subsidy I would simply die, because I could not afford my drugs and my body would reject my liver.”

Families USA is helping spread the word about stories like these, and we invite you to check out our interactive video here.

Ben D’Avanzo is government affairs associate and Claire McAndrew is private insurance program director for Families USA.