Public Health and HIV Advocacy Organizations File an Amicus Brief in a U.S. Supreme Court Case Challenging Affordable Care Act Tax Subsidies


The Center for HIV Law and Policy joined more than forty organizations in an amicus brief asking the U.S. Supreme Court to uphold an Internal Revenue Service (IRS) rule granting tax subsidies to individuals who purchase health insurance through federal exchanges under the Affordable Care Act (ACA).

The amicus brief argues that reversal of a ruling by the U.S. Court of Appeals for the Fourth Circuit in King v. Burwell would deprive millions of Americans of access to health insurance, seriously threaten health outcomes, and undermine the nation’s ability to address epidemics such as HIV and other health threats.

Opponents of the ACA argue that the statute only allows the IRS to grant tax subsidies for health insurance purchased through state-run exchanges, and that the IRS exceeded its authority by granting tax subsidies to those enrolled through both federal and state-run insurance exchanges.

Only 14 states have established their own exchanges; the federal government created exchanges in the other 36 states.

The federal district court found that the statute is ambiguous, but held that the IRS rule is “a permissible exercise of the agency’s discretion.” The ruling was upheld on appeal.

The amicus brief presents studies showing that federal subsidies are critical to accomplishing the ACA’s goal of achieving near-universal health insurance access, and that eliminating subsidies in states where federal exchanges operate would harm vulnerable populations and households at every income level.

Citing the experience with expanded health insurance access in Massachusetts, the amicus brief shows that greater access has a demonstrable effect in controlling the HIV epidemic and improving individual health outcomes.

The amicus brief also highlights that the challengers’ proposed interpretation of the ACA would harm the nation’s ability to fight epidemics and other emerging public health threats. By depriving millions of people access to health insurance, a victory for the challengers would negate public health gains in a majority of states, thwarting national efforts to promote public health security to the detriment of the entire population.

Prepared by Harvard Law School’s Center for Health Law and Policy Innovation and Wilmer Hale, the brief was filed on January 28, 2015. Oral arguments are scheduled for March 4, 2015, and a decision is expected by June 2015.