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Amicus Curiae Brief in King v. Burwell Case cites harm to
patients if subsidies are overturned
January 28, 2015
(Washington) - The American College of Physicians (ACP) today -
along with other health care organizations - submitted an
amicus curiae (friend of the court) brief to the Supreme
Court of the United States in the King v. Burwell case,
urging the court to uphold the premium subsidies created by the
Affordable Care Act (ACA) in all states.
The petitioners argue that the ACA's language does not permit
the Internal Revenue Service (IRS) to issue premium tax credits and
cost-sharing financial assistance to individuals residing in states
with federally-operated health insurance Exchanges. Currently, the
federal government runs 34 state health exchanges, where millions
of people received premium tax credits to purchase health
insurance. The question before the Court is whether the IRS may
permissibly promulgate regulations to extend tax-credit subsidies
to coverage purchased through Exchanges established by the federal
government under section 1321 of the ACA. The Supreme Court is
scheduled to hear oral arguments in the case on March 4.
"ACP has long supported policy efforts to extend health
insurance coverage to all as well as providing tax credits to make
insurance more affordable," said David A. Fleming, MD, MS, MACP,
ACP's president. "A decision by the Supreme Court to overturn the
subsidies in a majority of the states would do grave harm to the
patients cared for by internists and other clinicians on the front
lines of medical care delivery."
The amicus brief was submitted on behalf of a coalition of
physicians, nurses, and community health centers who deliver care
to the millions of patients who depend on the ACA's premium
subsidies to access affordable care. According to the brief, filed
today with the U.S. Supreme Court, "Section 36B of the Internal
Revenue Code, which was enacted as part of the Patient Protection
and Affordable Care Act (ACA), authorizes federal tax-credit
subsidies for health insurance coverage that is purchased through
an 'Exchange established by the State under section 1311' of the
The brief notes that tax credits (premium subsidies) established
in the ACA as well as the insurance market reforms have enabled
millions of Americans to purchase health insurance. If the Court
decides in favor of the plaintiffs, millions will lose their health
insurance subsidies. This will likely lead many to drop coverage or
elect to go uninsured, driving up health insurance premiums for
those that remain covered. If health insurance subsidies for
federally-facilitated marketplace (FFM) plans were eliminated,
enrollment in ACA-compliant individual market plans would drop by
9.6 million, according to the RAND Corporation. The Urban
Institute/Robert Wood Johnson Foundation estimates the number of
uninsured would increase by 8.3 million.
"The patients cared for by ACP members and other clinicians
would be directly affected because the insured are much more likely
than the uninsured to have a regular source of care, receive needed
health care, and pay less out-of-pocket for their care," Dr.
Fleming concluded. "The uninsured are more likely to receive care
from safety-net providers and report to an emergency department or
outpatient physician's office as their usual source of care, rather
than a physician's office. The uninsured are less likely than the
insured to follow treatment recommendations: many uninsured report
not taking prescribed medications or seeking follow-up care after a
chronic disease diagnosis. The ACA has helped to address this
problem: according to a Commonwealth Fund survey, the number of
adults who reported having a medical problem but did not visit a
doctor or clinic, did not fill a prescription, or skipped a
recommended test, treatment, or follow-up due to cost fell for the
first time since 2003."
Members of the coalition who signed onto the brief include:
The American College of Physicians is the
largest medical specialty organization and the second-largest
physician group in the United States. ACP members include 141,000
internal medicine physicians (internists), related subspecialists,
and medical students. Internal medicine physicians are specialists
who apply scientific knowledge and clinical expertise to the
diagnosis, treatment, and compassionate care of adults across the
spectrum from health to complex illness. Follow ACP on Twitter and Facebook.
Contact: David Kinsman, (202) email@example.com