How the conflict over two federal appellate court rulings is resolved could determine the future of health care reform in Florida and the nation. The separate rulings issued Tuesday are divided over the legality of subsidies that help Floridians and residents in 35 other states buy health insurance on the federal exchange. It defies logic that Congress intended only to provide the premium subsidies in states that created their own marketplaces, and the courts should keep them in place.
The clear intent of the Affordable Care Act is to extend health insurance to as many Americans as possible. That requires affordable premiums, regardless of whether the coverage is obtained through the federal exchange or a state-run exchange. Yet two conservative judges on a three-judge federal appeals court panel in Washington concluded Tuesday that the federal law only allows the subsidies to be offered in states with their own exchanges. They focus on one poorly worded provision in the complicated law and ignore its overall intent, rejecting the government's argument that their narrow reading would produce absurd results.
As if on cue, another federal appeals court panel in Virginia unanimously agreed that the tax credits that subsidize the purchase of health insurance are legal regardless of which exchange is used. "It is clear that widely available tax credits are essential to fulfilling the Act's primary goals and that Congress was aware of their importance when drafting the bill,'' Judge Roger Gregory wrote.
In an ideal world, there would be no issue about whether health coverage was bought through a state exchange or the federal one. But Florida Republicans and conservatives in other states fought the Obama administration at every turn and refused to create state exchanges. That forced 5.4 million Americans to obtain coverage through the federal exchange, and the vast majority qualified for subsidies.
Despite website issues, constant political attacks and now a shortage of doctors in some limited plans, health care reform is working. More than 983,000 Floridians signed up for health coverage through the federal exchange, and more than 9 of 10 of them received a subsidy. Yet opponents who have failed to persuade Congress or the U.S. Supreme Court to overturn the Affordable Care Act continue to fight various provisions in the courts. If the full appeals court panels examine fairly the intent of the Affordable Care Act, they will conclude the subsidies are legal and this issue will never reach the U.S. Supreme Court.