Washington Post - Affordable Care Act Opponents Are Cherry-Picking Their History

Op-Ed

By Tom Harkin, Ron Wyden, Sander M. Levin, George Miller and Henry A. Waxman

The Affordable Care Act was created to improve the quality and affordability of health care for all Americans. Indeed, many people who didn't have -- and couldn't afford -- health insurance before the law have it now.

As the New England Journal of Medicine recently determined, an estimated 10 million Americans gained health insurance between September 2013 and this past April, and most of them received financial help to make their coverage affordable.

Despite this progress, the law's opponents continue to try to undermine it. They seem unwilling to recognize the implications of their actions. Repealing the Affordable Care Act would take us back to the days when health care was reserved for the healthy and wealthy.

In a series of legal challenges, opponents have inaccurately argued that Congress intended to provide financial help only to Americans living in the 14 states that directly run their own health insurance marketplaces, not in the 36 states that delegated administration of their marketplaces to the federal government.

This interpretation is wrong. As members of Congress who shaped and debated the legislation, we want to set the record straight.

This year, two federal appellate courts issued conflicting rulings on who qualifies for subsidies under the law. A three-judge panel from the Fourth Circuit Court of Appeals unanimously ruled that financial help with premiums is appropriately provided to people throughout the country, no matter where they live. A panel from the D.C. Circuit Court of Appeals, in a 2 to 1 decision, reached an opposite ruling. That judgment, however, has been vacated, and the full court will rehear the issue soon.

None of us contemplated that the bill as enacted could be misconstrued to limit financial help only to people in states opting to directly run health insurance marketplaces. In fact, as chairs of the three House committees that collectively authored the health-care reform legislation (Ways and Means, Energy and Commerce, and Education and the Workforce), three of us issued a joint fact sheet in March 2010 reflecting our intention that financial help would be available to consumers in the state marketplaces, whether the state were to run it directly or via the federal government.

On the Senate side, provisions from the bill reported by Sen. Harkin's Health, Education, Labor and Pensions Committee were combined with provisions from the bill reported by the Finance Committee, of which the current chairman, Sen. Wyden, was a senior member. There, too, the final bill embodied our universal understanding that financial assistance would be available in every state.

The respected, nonpartisan Congressional Budget Office came to the same conclusion.

When we asked it to estimate the cost of our legislation, the CBO understood our intent and repeatedly provided fiscal projections based on the availability of financial help in every state and the District. Even though early political opposition to the Affordable Care Act made it apparent that some governors might refuse to directly run their own marketplaces, thereby delegating such administration to the federal government, the CBO's projections always correctly assumed that financial help would be available to qualifying individuals and families regardless.

However, those who brought the recent lawsuits have developed a fanciful notion about Congress's intentions. They assert that we intended to compel all states to run marketplaces directly by penalizing residents of those states that refused to do so.

But the law expressly provides that low- and middle-income Americans and their families will receive financial help to make their coverage more affordable. In an attempt to make their case, the law's opponents cherry-pick one four-word phrase -- "established by the State" -- from the formula used to determine how much financial help Americans are eligible to receive and use this phrase to argue that assistance isn't available to people living in states that decided to use the federal marketplace. But the language on which the law's opponents rely means no such thing.

Every state is required to have a marketplace to help Americans shop for affordable coverage. While states can set up a marketplace themselves, the law directs the federal government to set up "such" exchanges in states that do not. The law requires the federally facilitated marketplace to be functionally the same as marketplaces established by states -- making clear that an exchange created by the federal government is, as a matter of law, "an Exchange established by the State" -- and people are entitled to financial assistance regardless of which type of marketplace they use.

The Affordable Care Act was designed to make health-care coverage affordable for all Americans, regardless of the state they live in. Providing financial help to low- and moderate-income Americans was the measure's key method of making insurance premiums affordable. Without it, millions would remain uninsured, and for them, the new law would be nothing more than an empty, unfulfilled promise.

Before health-care reform, the need for affordable insurance was universally documented across all states. Americans who could not afford insurance had to choose between putting food on the table and purchasing needed medicines. Many went without medical treatment, faced bankruptcy or even risked premature death. These problems affected families regardless of where they lived.

The Affordable Care Act makes financial help available to working Americans in every state. That is the law we intended. That is the law we enacted. That is the law that is covering millions of people through marketplaces. And that is the law that should continue to be in force.