Supreme Court Ruling Against ACA May Force Action in States

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March 4 — A Supreme Court ruling stopping Affordable Care Act subsidies in three-quarters of the U.S. would place immediate pressure on governors who have kept the health law at arm's length.

The court heard arguments March 4 in King v. Burwell, a case challenging insurance premium subsidies in states that didn't build marketplaces under the Affordable Care Act. The justices may not issue a decision until late June (see related story in this issue).

Only 16 states built the online and telephone services called exchanges; the rest use the federal system. As many as 87 percent of ACA customers get subsidies. A ruling that ends them in 34 states would dramatically raise insurance premiums for an estimated 7.5 million Americans.