Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Supreme Court Upholds Subsidies in King v. Burwell Decision

By Jacqueline DiChiara

- The Supreme Court has ruled on King v. Burwell, a stunningly significant healthcare lawsuit intended to formally unravel various foundational components of the Affordable Care Act (ACA). The ACA has been upheld, as the Supreme Court issued a 6-3 decision. The Supreme Court ruled that the overarching context and structure of the ACA means Congress intended financial assistance to be available to residents of all states. Such does not depend upon how states’ exchanges are managed.

King v. Burwell

“We must determine whether a Federal Exchange is ‘established by the State’ for purposes of Section 36B. At the outset, it might seem that a Federal Exchange cannot fulfill this requirement. After all, the Act defines ‘State’ to mean ‘each of the 50 States and the District of Columbia’ — a definition that does not include the Federal Government,” according to key wording regarding the Supreme Court’s decision. “But when read in context, ‘with a view to [its] place in the overall statutory scheme,’ the meaning of the phrase ‘established by the State’ is not so clear.”

As King v. Burwell is uniquely considered one of the most important cases no one has ever heard of, what’s next on the healthcare horizon? Will earlier King v. Burwell predictions come to fruition? Perhaps considering today’s King v. Burwell decision within the greater context of recently proposed predictions regarding the anticipated aftermath that may soon unfold is essential to best understand what comes next.

Said Joel White, President of the Council of Affordable Health Coverage, to RevCycleIntelligence.com earlier this week, regardless of the King v. Burwell decision made today, within the upcoming decade, a staggering 50 percent of a typical family’s income may soon be spent on healthcare premiums.  

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  • White additionally predicts a ruling for Burwell means a “literal avalanche” in July of active legislative activity introduced from Congress members will follow.

    Susan Feigin Harris, Esquire, Healthcare Partner at Baker & Hostetler, LLP, stated to RevCycleIntelligence.com earlier this week that a Supreme Court ruling for King would have meant a “downward death spiral” would occur for healthcare revenue.

    According to Merrill Matthews, PhD, Resident Scholar with the Institute for Policy Innovation, (IPI) in a June 24 IPI press release, taxpayers will likely save $700 billion over the course of the next 10 years due to the existence of fewer insurance subsidies.

    According to February coverage from RevCycleIntelligence.com, a decision in opposition to the King v. Burwell Administration will create widespread havoc. Indeed, the ACA has already cut revenues by $600 million between 2010 and 2014, significantly reducing reimbursements that would have otherwise been received via Medicare.

    Stated Sylvia M. Burwell, Secretary of the Department of Health and Human Services (HHS), “We know of no administrative actions that could, and therefore we have no plans that would, undo the massive damage to our health care system that would be caused by an adverse decision.”

    As opinions swirl today regarding upcoming aftermath and developing opinions, the healthcare industry exists in a new realm of legislative progression and change.

     

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