HEALTH-CARE LAW’S CRITICS SEE COURT CASE OVER SUBSIDIES AS THEIR LAST SHOT

This story first appeared in The Washington Post

Opponents of the health-care law took their latest legal challenge to a federal courtroom in the District on Tuesday in a case that many critics of the law view as their last and best chance to gut it before key provisions kick in Jan. 1.

Though some legal scholars view the case as a long shot, it could have significant consequences if it is successful. Millions of people in 34 states could be denied the government subsidies established by the law to help low- and middle-income people pay their health-insurance premiums starting next year.

Even those who think the case has no merit are closely watching it unfold.

“You can no longer take a look at an allegation that on its face appears to have no merit whatsoever and simply dismiss it out of hand,” said Sara Rosenbaum, a health-law professor at George Washington University and a supporter of the Affordable Care Act. “All you need is a very energetic plaintiff and a sympathetic judge. It takes very little to set a case in motion.”

It is one of a number of cases bubbling up through the court system more than a year after the Supreme Court upheld the law, dealing a blow to those who have viewed the law as an unconstitutional and un-American infringement of their freedom. Now, the lawsuits are centering more on the way the law is being implemented.

The most visible lawsuits are those questioning the law’s requirement that businesses provide people health insurance that covers contraception. Last week, the Supreme Court agreed to consider a case brought by the owners of Hobby Lobby, an arts-and-crafts chain, who said the new mandate that they cover birth control runs counter to their religious principles.

Supporters of the mandate have said it protects the rights of workers to get certain benefits regardless of their employer’s religious views.

Also on Tuesday, AIDS advocates in St. Louis filed suit against the state of Missouri for passing laws that restrict the activities of “navigators” — helpers who are paid through federal grants to assist people as they sign up for health insurance. They argue that the rules, which among other things require navigators to be certified by the state, conflict with federal law.

Supporters of the navigator restrictions say they were necessary to protect consumers from being misled by poorly trained or unethical navigators.

But the case heard before District Court Judge Paul L. Friedman on Tuesday could have more serious consequences for the overall health-care law.

At issue are the subsidies that low- and middle-income people are set to receive next year. The plaintiffs — three private employers and four individual taxpayers — argue that Congress intended the law’s subsidies for low- and middle-income people to go only to people in states that set up their own health-insurance exchanges.

The exchanges are online marketplaces where people are supposed to be able to log on to browse health-plan features and prices, apply for subsidies and enroll in coverage. Thirty-four states opted not to set up their own marketplaces, leaving the task up to the federal government.