On March 4, 2015, the U.S. Supreme Court heard arguments in the case of King vs. Burwell. The Supreme Court’s decision on this case will have significant implications for the capacity of the Affordable Care Act (ACA) to reduce the number of uninsured persons in the United States. In this brief we provide an overview of the potential impact of this case on the implementation of the ACA.
Background: The ACA’s Coverage Expansion Mechanisms
The ACA expanded access to health insurance coverage through two primary mechanisms. The first mechanism is an expansion of the Medicaid program through the extension of eligibility to individuals with modified adjusted gross income up to 138 percent of the Federal Poverty Level (FPL) (approximately $33,465 for a family of four). The primary beneficiaries of this expansion are low-income childless adults, as Medicaid eligibility for adults historically has been tied to parental status except at the lowest income levels. In 2012, the U.S. Supreme Court ruled that states could choose whether or not to expand Medicaid, and 30 states, including the District of Columbia, have done so to date.