What the Supreme Court Challenge Means for the Health-Care Law

Kim Jones, a substitute teacher, worries she will lose her health insurance if the Supreme Court strikes down a core provision of the Affordable Care Act in her state.

Lou Moshakos, the head of a restaurant company in nearby Raleigh, is also waiting for the court, but with a sense of optimism. A weakened law might remove the threat of fines if he doesn’t provide insurance for his waiters.

On Wednesday, the court will hear oral arguments on a challenge to subsidies received by millions of Americans, in as many as 37 states, who purchased health insurance through a federally run exchange. The suit represents one of the biggest threats to the Obama administration’s signature domestic achievement since it passed, rivaling a 2012 legal challenge the law survived.

Kim Jones, a part-time substitute teacher says she couldn’t
 afford Health Insurance if the Supreme Court invalidates
 the subsidy. Photo: Travis Dove for The WSJ

Supporters of the health law say a win for the plaintiffs would leave millions more people uninsured by making their premiums unaffordable. Opponents say it would free many people and businesses from the threat of penalties for choosing to skip insurance, and would also prompt an exploration of health-care alternatives. A decision in the case, King v. Burwell, is expected around June.

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The law has put down roots even in unfriendly territory such as North Carolina, where, despite opposition to the ACA from political leaders, almost 560,000 residents have signed up for coverage under it. Backers and opponents alike agree that a successful legal challenge could render the health law as written largely unworkable in many states by gutting central components. This could force the new Republican-controlled Congress and the White House back to the negotiating table to rework the law, even as it would send state lawmakers searching for solutions for newly uninsured residents.

More than 30 states didn’t set up one of the exchanges, or marketplaces, that the health law envisioned for purchasing insurance. That left their residents to shop on a digital exchange the federal government set up, HealthCare.gov.

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