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10 things you should know about the latest Affordable Care Act court case
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On Wednesday, the Supreme Court heard oral arguments for the latest case threatening the Obama administration's signature legislation. - photo by Kelsey Dallas
This week, the Supreme Court heard arguments in the latest legal challenge to the Affordable Care Act. The case, King v. Burwell, focuses on whether the federal government can legally provide financial support to people enrolled in the ACA in states that haven't set up their own insurance marketplace.

A ruling against the law would impact millions of Americans' ability to afford insurance and would also likely energize efforts to repeal and replace the ACA.

The court's decision isn't expected until the end of June, but the legal battle will likely remain in the news over the next three months as ACA supporters highlight the people helped by the law and detractors focus on replacement plans.

Here are answers to 10 basic questions about the case, the law and possible outcomes:

What's being debated?

At the heart of the case are the approximately 8 million people receiving tax subsidies to purchase insurance in the 34 states without their own health insurance marketplaces.

The Internal Revenue Service currently offers tax subsidies to any ACA enrollee deemed unable to pay for health insurance coverage. However, in one section of the law, these subsidies are promised only to those who receive insurance "through an exchange established by the state," a post from the Brookings Institution's health policy blog explains.

If that language is taken at face value, individuals in the 34 states that didn't set up their own health insurance marketplace will no longer be eligible for financial assistance. However, the administration thinks the "clear intent" of the ACA was to allow for subsidies through the federal marketplace, a condition that could render one confusing passage unimportant.

What's at stake?

It depends on who you ask. Advocates of the ACA say that King v. Burwell holds the potential to gut the entire law. Yale Law School professor Abbe Gluck told Slate's Dahlia Lithwick the real-world consequences of the case "cannot be understated." She noted that a loss of subsidies in the states without their own marketplaces would mean around 8 million Americans would stop being able to afford insurance.

However, for vocal opponents of the health care law, the case is an opportunity to correct five years of government overreach. Jonathan Adler, one of the masterminds behind the current lawsuit and a law professor at Case Western Reserve Law School, told Lithwick he wants the focus to be off worst-case scenarios for the ACA and on the administration's problematic understanding of the IRS's ability to provide subsidies.

How many people will be affected?

As of mid-February 2015, the end of the ACA's second open enrollment period, around 11.4 million Americans were enrolled in private health insurance programs through state or federal marketplaces, Reuters reported. Although a ruling against the ACA this year would only directly impact the around 8 million people who need the subsidies to afford insurance, its spillover effects could put the entire law at risk.

What happened during Wednesday's court appearance?

Lawyers for both sides offered oral arguments and things got pretty heated. According to The New York Times, the justices appeared "bitterly divided" at the outset, with four of the more liberal members of the court openly supporting the administration's argument. The decision will likely come down to a single vote, the Times reported, and their money is on either Chief Justice John G. Roberts Jr. or Justice Anthony M. Kennedy to be the swing vote.

Hasn't the ACA been challenged in court before?

Yes. It's OK to experience a bit of dj vu. In June 2012, a 5-4 vote from the Supreme Court upheld the law's ability to require individuals to have health insurance, otherwise known as the individual mandate. Although King v. Burwell centers on a different aspect of the ACA, lawyers for both sides are the same as in 2012, making Wednesday's hearing a reunion of sorts.

What is President Obama saying?

It's safe to say the president is fed-up with ACA opponents. In his Jan. 20 State of the Union address, he highlighted the health care plan as one of the country's major achievements. "In the past year alone, about 10 million uninsured Americans finally gained the security of health coverage," he said.

And even when he doesn't address King v. Burwell directly, it's likely on his mind. As NPR noted, the fate of the signature legislation of his presidency (it's known to many as Obamacare, after all) hangs in the balance.

How will the case impact Congress?

Although Pew Research Center reports that 87 percent of conservative Americans oppose the ACA, the Republican-controlled Congress won't have much time to celebrate if the Supreme Court rules against the Obama administration. Instead, they'll be under "tremendous pressure" to either pass an update to the ACA or present a replacement law, in order to protect the health insurance coverage of millions of Americans, NPR reported.

What else is on the horizon for the ACA?

Deseret News National reported in January on what 2015 will likely hold for the ACA, highlighting the headache it could add to an already stressful tax season. People who received a tax subsidy will have to reconcile their income for every month they took part in a marketplace insurance plan. Additionally, the IRS will be on the lookout for Americans who were uninsured for all or part of 2014, a violation of the ACA's individual mandate.

How does the ACA fare in public opinion polls?

In the five years since the ACA was signed into law, public opinion has been relatively constant. As of last month, 53 percent of Americans disapproved of the law and 45 percent approved, according to Pew Research Center.

Where can I learn more?

Major news organizations like The Washington Post and The New York Times are offering consistent coverage, drawing on a wide variety of sources well-versed in ACA jargon and the political landscape. Additionally, health policy organizations like The Heritage Foundation and The Henry J. Kaiser Family Foundation post regular updates on their websites and social media pages.
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