The nation is bitterly split over the Affordable Care Act, and turmoil regarding its viability increased Tuesday after two federal appeals courts delivered radically different rulings on a key part of the law.
The judicial whiplash came in response to a dispute over who can buy subsidized insurance on the ACA's exchanges. This is just the lastest obstacle on the rocky road to a more inclusive and affordable health care system.
The act is clear that federal tax subsidies are allowed for people who qualify based on income, and who buy insurance through state-run exchanges. Less clear is whether the law authorizes the same subsidies for people who buy on federally run exchanges in 36 states where officials refused to establish their own. A three-judge appellate panel in Washington, D.C., ruled that the law doesn't authorize those subsidies. A similar panel based in Richmond, Virginia, ruled it does.
Nothing will change immediately for the millions of people who have the tax subsidy. Ultimately the U.S. Supreme Court will have to resolve this dispute, which cuts to the core of the act's attempt to expand coverage by making it more affordable.
Congress could clarify what it intended. But that's not going to happen. With Republicans determined to repeal the law and Democrats dug in to preserve it, the dueling decisions will only fuel the unending partisanship over the route to better health care.
This is not a new fight, only a continuation of the one that began in the battle to establish Medicare and Medicaid in 1965. It raged in 1993 over Bill and Hillary Clinton's failed attempt at reform. It bubbled as consumers drove private insurers to loosen their subsequent embrace of disastrous managed care plans. And it boiled again in 2003 over the prescription drug benefit added to Medicare.
What's clear is that we're careening down a one-way road. We can't go back. Costs were soaring uncontrollably and too many people were uninsured. Mapping the course ahead is the challenge.