February 23, 2015 | Issue Brief on Health Care
The Supreme Court will hear oral arguments on March 4 in the case of King v. Burwell—a challenge to an IRS rule under the Affordable Care Act (ACA) allowing the payment of premium subsidies to individuals enrolled in the federal exchange. Supporters of the ACA have made various claims about the harm that would supposedly occur were the court to find for the plaintiffs (King) in this case. While it is not surprising that those claims have attracted attention, an important, though often missing, context is the harm being caused by the ACA itself.
Following are eight groups of individuals who have been, or will be, specifically harmed by the law’s flawed policies:
Finally, even those individuals receiving premium subsidies through an exchange may face unexpected challenges. Due to the complex design of the ACA premium subsidy, it is much more likely that the subsidy will be inaccurately calculated. Any enrollee who receives a greater subsidy than he was eligible for will be required to repay the excess subsidy to the Internal Revenue Service when he files his annual tax returns. Repayments could be significant, depending on the enrollee.
While King v. Burwell is currently in the spotlight, in the end, the ACA and its flawed policies are at the root of the problems plaguing this law and are responsible for its harmful effects.
—Alyene Senger is a Research Associate in the Center for Health Policy Studies, of the Institute for Family, Community, and Opportunity, at The Heritage Foundation.
 Edmund F. Haislmaier, “King v. Burwell: Assessing the Claimed Effects of a Decision for the Plaintiffs,” Heritage Foundation Issue Brief No. 4349, February 20, 2015, http://www.heritage.org/research/reports/2015/02/king-v-burwell-assessing-the-claimed-effects-of-a-decision-for-the-plaintiffs.
 Congressional Budget Office, “Insurance Coverage Provisions of the Affordable Care Act—CBO’s January 2015 Baseline,” Table B-1, https://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2015-01-ACAtables.pdf (accessed February 20, 2015).
 Joint Committee on Taxation, “Estimated Revenue Effects of a Proposal to Repeal Certain Tax Provisions Contained in the ‘Affordable Care Act (“ACA”),’” June 15, 2012, and Congressional Budget Office, “Table 2: CBO’s May 2013 Estimate of the Budgetary Effects of the Insurance Coverage Provisions Contained in the Affordable Care Act,” https://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2013-05-ACA.pdf (accessed February 20, 2015). The total amount of tax revenue collected from the individual mandate, employer mandate, and 40 percent excise tax on high-cost health plans comes from the CBO’s May 2013 estimate. For all other taxes, the amount of tax revenue totaled comes from the Joint Committee on Taxation’s June 2012 estimation.
 Douglas W. Elmendorf, letter to Speaker of the House John Boehner (R–OH), July 24, 2012, pp. 13–14, http://www.cbo.gov/sites/default/files/cbofiles/attachments/43471-hr6079.pdf (accessed September 25, 2014). The CBO estimates the cost of repealing the ACA, which would increase Medicare spending due to the absence of the ACA’s Medicare cuts. If the law were repealed, “[w]ithin Medicare, net increases in spending for the services covered by Part A (Hospital Insurance) and Part B (Medical Insurance) would total $517 billion and $247 billion, respectively. Those increases would be partially offset by a $48 billion reduction in net spending for Part D.”
 U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, 2014 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Medical Insurance Trust Funds, July 28, 2014, pp. 208 and 209, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2014.pdf (accessed February 17, 2015).
 Elmendorf, letter to Speaker of the House John Boehner (R–OH), July 24, 2012, p. 14.
 Melinda Beck, “UnitedHealth Culls Doctors From Medicare Advantage Plans,” The Wall Street Journal, November 16, 2013, http://www.wsj.com/news/articles/SB10001424052702303559504579200190614501838?mod=WSJ_hp_LEFTWhatsNewsCollection (accessed February 17, 2015).
 “Shared Responsibility for Employers Regarding Health Coverage; Final Rule,” Federal Register, Vol. 79, No. 29, February 12, 2014, http://www.gpo.gov/fdsys/pkg/FR-2014-02-12/html/2014-03082.htm (accessed February 20, 2015). The authority of the Administration to take those actions is being challenged in another lawsuit, United States House of Representatives v. Sylvia Mathews Burwell, Case No. 14-cv-01967, http://online.wsj.com/public/resources/documents/HouseACAcomplaint112014.pdf (accessed February 20, 2015).
 Jed Graham, “ObamaCare Employer Mandate: A List Of Cuts to Work Hours, Jobs,” Investor’s Business Daily, September 5, 2014, http://news.investors.com/politics-obamacare/090514-669013-obamacare-employer-mandate-a-list-of-cuts-to-work-hours-jobs.htm (accessed February 13, 2015).
 Edmund F. Haislmaier and Drew Gonshorowski, “Q3 2014 Health Insurance Enrollment: Employer Coverage Continues to Decline, Medicaid Keeps Growing,” Heritage Foundation Backgrounder No. 2988, January 29, 2015, http://www.heritage.org/research/reports/2015/01/q3-2014-health-insurance-enrollment-employer-coverage-continues-to-decline-medicaid-keeps-growing.
 Amy Anderson, “The Impact of the Affordable Care Act on the Health Care Workforce,” Heritage Foundation Backgrounder No. 2887, March 18, 2014, http://www.heritage.org/research/reports/2014/03/the-impact-of-the-affordable-care-act-on-the-health-care-workforce.
 The Physicians Foundation, “2014 Survey of America’s Physicians: Practice Patterns and Perspectives,” p. 15, http://www.physiciansfoundation.org/uploads/default/2014_Physicians_Foundation_Biennial_Physician_Survey_Report.pdf/ (accessed February 12, 2015).
 Drew Gonshorowski, “How Will You Fare in the Obamacare Exchanges?” Heritage Foundation Issue Brief No. 4068, October 16, 2013, http://www.heritage.org/research/reports/2013/10/enrollment-in-obamacare-exchanges-how-will-your-health-insurance-fare.
 Kevin D. Dayaratna, “Studies Show: Medicaid Patients Have Worse Access and Outcomes than the Privately Insured,” Heritage Foundation Backgrounder No. 2740, November 7, 2012, http://www.heritage.org/research/reports/2012/11/studies-show-medicaid-patients-have-worse-access-and-outcomes-than-the-privately-insured.
 Congressional Budget Office, “Insurance Coverage Provisions of the Affordable Care Act—CBO’s January 2015 Baseline,” Table B-2, https://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2015-01-ACAtables.pdf (accessed February 20, 2015).
 Congressional Budget Office, “Insurance Coverage Provisions of the Affordable Care Act—CBO’s January 2015 Baseline,” Table B-2.
 Congressional Budget Office, “Payments of Penalties for Being Uninsured Under the Affordable Care Act: 2014 Update,” June 2014, Table 1, https://www.cbo.gov/sites/default/files/45397-IndividualMandate.pdf (accessed February 20, 2015).
 Alyene Senger, “Obamacare Makes Tax Time More Taxing,” The Daily Signal, February 6, 2015, http://dailysignal.com/2015/02/06/obamacare-makes-tax-time-taxing/.