Supremes hear 'Obamacare' again

The Supreme Court convened at 10 a.m. local time (1500 UTC) Wednesday to hear King v. Burwell, the latest challenge to the Affordable Care Act (ACA) and a legal case that jeopardizes insurance coverage for millions of people. Right-wing operatives have fought "Obamacare" - the president's attempt to bring something approximating universal health care to the United States and a central part of his legacy - since the law passed over unified Republican opposition in 2010. The ACA's passage had allowed about a quarter of the 50 million uninsured Americans to participate in the private health market.

Backed by a right-wing group called the Competitive Enterprise Institute, the plaintiffs want to see federal subsidies thrown out for certain people who have purchased health insurance under the ACA. However, Justice Anthony Kennedy said that would unlawfully pressure states and cause an insurance "death spiral."

If the court rules against Obamacare, up to 8 million people in 34 states would lose subsidies, according to the consulting firm Avalere Health. Hinging on "established by the state" - four words in the 974-page law passed - the case asks the court to cancel subsidies for millions who bought insurance on federal exchanges put in place for the 34 states where officials declined to participate in ACA. The marketplaces allow Americans to pick from private plans, offering tax subsidies for lower-income people who cannot get health care from their employers.

Long wait

Not a truly public plan, the ACA requires Americans to buy private insurance if they do not receive coverage through their employers or the hard-to-access government Medicare and Medicaid programs for people with lower incomes. Ninety percent of those who buy from exchanges qualify for subsidies.

A couple hundred demonstrators - including labor unions, a nurses' organization, Planned Parenthood and women's groups - gathered on the sidewalk in front of the white marble-columned courthouse ahead of the argument on Wednesday. "You shouldn't have to choose between a roof over your head or health care," Michelle Boyle, a nurse from Pittsburgh, told the Reuters news agency on Wednesday.

Obamacare survived a 2012 court challenge 5-4. John Roberts, the chief justice appointed by George W. Bush, sided with the court members considered liberal to uphold the law on constitutional grounds. A ruling on the fate of the signature domestic policy achievement of US President Barack Obama should come by the end of June.

Last fall, Republicans campaigned in part against health care reform in the US midterm elections, ultimately hitting Democrats with a "political earthquake."

mkg/ (Reuters, AP)