Published June 29, 2015
The recent Supreme Court ruling affirming nationwide tax credits for mandatory insurance coverage under the Affordable Care Act preserves access to affordable health insurance in all 50 states and – over time – will help narrow the health outcomes gap between lower- and higher-income Americans, according to an expert in health equity and law at the University at Buffalo.
“We all deserve a chance to live healthy lives, no matter what state we happen to live in,” says Danielle Pelfrey Duryea, an instructor and clinical teaching fellow at the SUNY Buffalo Law School who teaches the Health Justice Law and Policy Clinic.
Pelfrey Duryea called the 6-3 Supreme Court ruling, which protects more than 6 million Americans receiving tax credits intended to make mandatory insurance coverage affordable, “quite unexpected – both the decision itself and the margin of the majority.”
“The court was widely expected to hold that the wording of the Affordable Care Act barred the federal government from subsidizing private health insurance for low-income people in any of the 30-plus states that have chosen not to set up their own health insurance marketplaces, but instead rely on the federal exchange to serve their citizens,” says Pelfrey Duryea.
In the short term, an estimated 6.5 million people would have lost access to health insurance, according to Pelfrey Duryea.
“More than 6o percent of these people are white, more than half of them hold a high school education or less,” she says. “Almost half of them are employed full time. Many Midwestern and Southern states declined to establish their own exchanges, yet more than 85 percent of the people who would have lost access to insurance live in those regions of the country.”
The longer-term implications of this ruling are just as striking, according to Pelfrey Duryea. A different decision could have “destabilized the whole architecture” of the Affordable Care Act, with side effects that would have hit even states such as New York that have their own health insurance exchanges.
“We know that low-income Americans suffer worse health outcomes, on average, than higher-income citizens. And we know that this outcomes gap derives in part from the historical gap between insured and uninsured that the ACA was designed to close,” she says.
“People without health insurance don't receive preventive care, delay seeking treatment when they do become ill and must often rely on emergency medicine for primary care needs – all of which are ultimately far more expensive to the health care system than helping people afford to insure themselves.”
In affirming that the federal government may provide this assistance to citizens of any state, the Supreme Court brought significant new certainty and stability to a statute that has been under legal attack for years, according to Pelfrey Duryea.