Health care reform in jeopardy ? ?

The intent of the Affordable Care Act is perfectly clear that congress intended to make health insurance possible for all American citizens.    Wealthy people could pay for their own;   middle class working people would mostly get it through their jobs or on the exchanges;  seniors would get it through Medicare;  people below a certain poverty level would get it through Medicaid, and the eligibility for Medicaid was expanded to include millions more people.

Then, for another group of people whose income is too much to be eligible even for the expanded Medicaid limits, but not enough to afford insurance through the marketplace exchanges, the ACA provided for subsidies through income tax credits.    The intent is clear.

But in one place, the law as written refers to subsidies for those through state exchanges without mentioning the federal exchanges.     The unanticipated problem is that recalcitrant, politically motivated governors and state legislators have refused to set up state exchanges.   There are only 16 operating.    In the other 34 states, people use the federal exchanges in lieu of their state having provided an exchange.

But when the law was written and passed by congress, it was anticipated that most, if not all, of the states would set up exchanges.   The anticipated use of federal exchanges was expected to be small -- really just a sort of back up plan.   But of course that changed after the ACA had become law.

The Congressional Budget Office as well as the HHS administrators have all interpreted that sentence generously, based on the obvious intent.   But some people have sued, hoping to block any part of Obamacare that they can;   and now we're getting the results of those suits.

A 3 judge panel of the 10th Circuit Court of Appeals has ruled 2 to 1 against that interpretation, saying that subsidies cannot, under this wording, be paid for insurance obtained through the federal exchange.    Pulling this lynch pin out could destroy the whole program, which is made up of so many interlocking parts.

But just four hours later, the 4th Circuit Court of Appeals ruled the exact opposite by a 3 to 0 vote.   The administration plans to ask for a full panel vote in the 10th Circuit decision.   With a 7 Democrat/4 Republican makeup, the panel's decision will likely be overturned.  Of course the plaintiffs in the 4th Circuit could also ask for a full court decision;  but again justices appointed by Democratic presidents are in a majority on that court.

So the jeopardy may be avoided, but that shows how determined some people are for us not to have the health care reform, which is actually working -- both for the 10 million people covered and also in the evidence that the ACA can actually help control increases in health care costs.

Ralph