The Law and Health Care for Millions: Rallying Outside the Supreme Court


March 6, 2015

Dr. Alice Chen is executive director of Doctors for America. She and Ron Pollack, who directs Families USA, were among the key leaders organizing a rally in front of the Supreme Court while oral arguments were going on that might determine the fate of the Affordable Care Act. Alice’s smile (at the right) embodied the energy and spirit at the rally.

So did Ron Pollack (see my none-too-good photo below of Ron, with Congressman Xavier Becerra (D-CA) at the left). Ron had been inside hearing the arguments and came out to report that it had gone well for the proponents of the Affordable Care Act.

SCOTUS Pollack and BacerraRon is a lawyer, and a decades-long champion of health care for all. Alice is a physician, and another passionate champion. I was thinking hard about the perspectives of law and medicine, standing in the drizzle outside the Court. Justice Kennedy, whose vote may well determine the outcome, did not seem to doubt that millions of people would lose health coverage if the Court rules against providing subsidies in states without their own health insurance exchanges. By the accounts of numerous lawmakers, their intent was indisputably to provide subsidies whether states created their own exchanges or used the federal one. Could four words in the statute – “established by the state” – really limit the tax credits subsidizing the cost of care only to those states that set up their own exchanges? The rest of the law has many provisions clearly assuming the availability of those credits nationwide. Mr. Bumble in Charles Dickens’ Oliver Twist famously contended that “the law is a ass” – but could it be that much of one?

Would an interpretation of four words of law wipe out access to medical care for millions? That’s what the doctors, as well as individuals whose own care hangs in the balance, came to the rally to speak about.

Of course, if Congress was interested in avoiding the loss of health coverage for millions on a technicality, it could make a tiny correction in the wording. Justice Scalia, in probing whether the loss of coverage would occur, asked Solicitor General Donald Verrilli: “You really think Congress is just going to sit there while all these disastrous consequences ensue?” Mr. Verrilli answered, “This Congress?” As reported in The Wall Street Journal, “the audience erupted in laughter.”

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