In the wake of a Republican electoral takeover, the political Right just got more good news. The Supreme Court decided to take up King v. Burwell, the latest legal challenge to the Affordable Care Act. Understanding this challenge to the law requires understanding of the complex architecture of the ACA, so here goes.
To expand coverage to those with pre-existing conditions, a major goal of the ACA, Congress did three things. First, it forbade insurers from turning down those seeking insurance who had a pre-existing condition; this is called guaranteed issue. But to ensure that people didn’t game the system and just enroll for insurance when they got sick and needed care (which was my plan once I found out about the ACA), they created the individual mandate, requiring United States citizens to have health insurance at all times. This mandate was declared unconstitutional in a prior Supreme Court challenge to the law, but it survived by being construed as a tax. Continue reading