Health care subsidies were rescued in the U.S. Supreme Court’s King v. Burwell decision, but questions remain about the costs of the Affordable Care Act to consumers.
“There’s going to be a debate in the future about whether or not there’s adequacy of coverage or people are still going bankrupt even though they had a policy because they had this out of pocket exposure,” said Earl Pomeroy, senior counsel in Alston & Bird’s Legislative & Public Policy Group. “I think that’s a debate that’s inevitably going to come, but given that most of the people participating in the exchange coverage – some several million of them – are doing so through the benefit of the premium subsidy, I’d say it’s working for a good many.”
Colin Roskey, partner in the firm’s Health Care Group, also noted that government oversight of subsidies has shown many instances in which they have been applied for and been delivered but later deemed too excessive, requiring individuals to pay them back.
“The system by which individuals whose income may fluctuate and who apply for a subsidy and then subsequently have to reconcile that against a future change in their income creates oversight problems for the Internal Revenue Service that I think probably need more streamlining going forward,” he said.
“I think it’s acknowledged that the system isn’t perfect,” Roskey said, but he echoed the view that it is an essential element in the goal of the Affordable Care Act and of universal coverage.