About 931,000 Floridians could lose $4.8 billion in subsidies to buy health insurance if a federal appeals court decision Tuesday striking down a major part of President Barack Obama's signature health care law is upheld.
The ruling in Halbig vs. Burwell by the U.S. Appeals Court for the D.C. Circuit could mean premium increases for millions of Americans who rely on federally run insurance exchanges because their states would not create their own.
However, within hours of the ruling, another three-judge panel on the 4th U.S. Circuit Court of Appeals in Richmond, Va., came to the opposite conclusion, supporting the subsidies and throwing the Affordable Care Act into yet another legal tangle.
The Obama administration emphasized that policyholders will keep getting financial aid as the legal implications are sorted out.
Since the Washington case was decided by a three-judge panel, the administration will ask the full 11-member appeals court to hear the case. The full U.S. Court of Appeals for the District of Columbia Circuit has seven judges appointed by Democratic presidents, including four by Obama. If the court refuses to hear the case, or lets its three-member panel stand, then the U.S. Supreme Court would likely weigh in.
The three judges in Washington ruled 2-1 that the Affordable Care Act, as written, allows insurance subsidies only in states that have set up their own exchanges. The decision invalidated an Internal Revenue Service regulation that allowed subsidies in all 50 states.
Without subsidies, Floridians in the federal exchange would see their premiums rise by an average of 80 to 95 percent, according to a new report from consulting firm Avalere Health.
A recent report from the Robert Wood Johnson Foundation estimated that 7.3 million people, or about 62 percent of those expected to enroll in federally run marketplaces by 2016, could lose out on $36.1 billion in subsidies if the Halbig plaintiffs prevail.
Residents in Texas and Florida would lose the most, $5.6 billion and $4.8 billion in subsidies.
Nearly 1 million Floridians bought health insurance on the exchange this year, 90 percent of them with the help of subsidies, according to a recent report from Kaiser Family Foundation.
"Floridians are at the mercy of the rigid ideology of Republican Gov. Rick Scott and legislators who refused to set up a Florida marketplace, expand health services to a million Floridians under Medicaid and even took away the insurance commissioner's ability to oversee insurance company rate increases," U.S. Rep. Kathy Castor, a Tampa Democrat, said in a statement. "Hopefully, on appeal, the hundreds of thousands of our neighbors who finally have affordable health insurance will maintain access to their valuable tax credits."
Florida Senate President Don Gaetz, R-Niceville, said he continues to oppose a state exchange.
"As long as I serve in the Senate, I will never support the state of Florida serving as the instrument by which individuals and businesses are forced into a federal mandate to purchase a health insurance product they may not want," he said in a statement. "Maybe I'm just partial to the legislative process designed by our founding fathers, rather than the dictates of unelected bureaucrats who seem to change the application of this law as often as President Obama plays a round of golf, but perhaps we ought to look to those members of Congress who not only supported this law but suggested that it be voted on before it was read and see if they can suggest a legislative solution. Alternatively, President Obama could propose a solution to fix this inherent problem with his signature piece of legislation."
Florida House Speaker Will Weatherford and Gov. Rick Scott also used the D.C. ruling to criticize the law. Weatherford said "the uncertainty surrounding Obamacare indicates it is a poorly crafted and confusing law."
"This is a bad law," said Scott, "and somehow Charlie Crist is still saying its been 'great.' "
Crist, the former Republican governor now turned Democratic challenger against Scott, said Scott has failed to lead on health care. "If Scott gets his way, we will go back to a time when insurance companies could deny care for those with pre-existing conditions and force young people off their parents' insurance," said Crist spokesman Brendan Gilfillan.
Families USA, a consumer group that advocates the health care law, downplayed the D.C. court ruling, saying it would most likely never go into effect. "Today's decision represents the high-water mark for Affordable Care Act opponents, but the water will recede very quickly," said executive director Ron Pollack.
Yet his and other organizations say the D.C. ruling, if it were to stand, could be devastating for many consumers.
"Millions of people already get their private health insurance through federally facilitated marketplaces, and millions more will do so in the coming years. For most of these individuals, federal subsidies make the difference in being able to afford health insurance," said Dr. John Lumpkin, senior vice president at the Robert Wood Johnson Foundation, in a recent statement. "If financial help is available to people living in some states but not others, it will widen the substantial health insurance disparities in our nation, making it harder for millions to access the care they need."
Information from the Associated Press and Kaiser Health News was used in this report.