CNN provides an easy to understand primer on what's at stake this time around. Find the article, "The latest Obamacare challenge: What you need to know" here.
The article explains that the law establishes the creation of exchanges "through which individuals can purchase competitively priced health insurance". Sixteen states and the District of Columbia have set up their own exchanges. Folks living in the other 34 states must use the exchange run by the federal government. And the law provides federal tax credits to income eligible individuals "to help offset the cost of the policies".
Most of us remember all of this. States set up their exchanges where you shop for your healthcare coverage. Lots of governors or state legislatures chose not to create their own exchanges, so their citizens go to the exchange run by the federal government. And because everyone is supposed to sign up if they don't have coverage elsewhere, the Affordable Care Act provided federal tax credits to help lower income individuals and families buy coverage.
Simple enough. Except, those bringing the case that is now before the Supreme Court say the law did not authorize those tax credits for those having to use the federal run exchange. That's where the four words in the law passed by Congress comes in.
A synopsis from the CNN article:
The health care law provides for the
establishment of "exchanges" through which individuals can purchase
competitively priced health insurance. It also authorizes federal tax credits
to low- and middle-income Americans to help offset the cost of the policies. Currently 16 states plus the
District of Columbia have set up their own exchanges; the remaining 34 states
rely on exchanges run by the federal government. Those bringing the case say that the
words "established by the State" in a subsection of the law make
clear that subsidies are only available to those living in the 16 states that
set up their own exchanges. If
the court says the IRS rule is invalid, absent some kind of action by the
states or Congress, more than 5 million individuals will no longer be eligible
for the subsidies, shaking up the individual market.
The government, defending the law, says: the language at issue is a "term of art" and that Congress always intended the subsidies to be available to everyone. ... it was clear that some states would not establish their own exchanges.
There is a little technicality that is also interesting. Challenges must have standing - that is to say that have to show that they are being harmed by the law. The challengers in this case are residents of Virginia, one of the 34 states that did not create their own exchange. So these Virginia residents don't get the tax credits. Without the tax credits they can't afford health care coverage offered through the federal exchange. So sounds like they want the tax credit. Apparently not. Remember the "individual mandate" part of the Affordable Care Act - if you don't get coverage, you get a penalty?
As CNN explains:
The crux of their argument is that
if it were not for the tax credits for premiums, they could not afford health
insurance and thus would be exempt from the individual mandate to purchase
health insurance.