title: Update on the Affordable Care Act. King v. Burwell and Obergefell v. Hodge.
abstract: Patients with respiratory diseases, critical illness, or sleep disorders who lack health insurance endure disparities in access to care and worse health outcomes. These disparities were partly addressed in the United States in 2010 by passage of the Affordable Care Act. Low- and moderate-income individuals and families with incomes between 138 and 400% of the federal poverty level are eligible for insurance premium subsidies when purchasing policies on the health insurance marketplace exchanges. Since the act was passed, nearly 16.5 million Americans have gained health insurance. In 2015, the act survived what may be the last significant judicial challenge to the law: King v. Burwell. The plaintiffs challenged whether people who purchased health insurance in states that use the federal insurance marketplace HealthCare.gov , rather than a state-run marketplace, were eligible to receive insurance premium subsidies. At the time of the ruling, 34 states used the federal exchange, and as a result, nearly 7.5 million people could have lost their health insurance if the court had ruled in favor of the plaintiffs. However, in King v. Burwell, the Court ruled six to three in support of the legality of subsidies regardless of type of marketplace states use, thereby ensuring continued health insurance coverage for patients in states using the federal marketplace exchange. In 2015, the Supreme Court also heard a landmark case, Obergefell v. Hodge, in which the Court upheld the right for two people of the same sex to marry, thereby opening crucial access to both state and federal benefits and protections for same-sex couples.
authors.affiliation: 1 Division of Pulmonary, Allergy and Critical Care, Hospital of the University of Pennsylvania, and.|2 Division of Pulmonary and Critical Care Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Lyon
authors.affiliation: 3 American Thoracic Society, Washington, DC.
authors.forename: Nuala
authors.initials: N
authors.lastname: Moore
authors.affiliation: 4 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver and Denver Health Medical Center, Denver, Colorado; and.
authors.forename: Ivor S
authors.initials: IS
authors.lastname: Douglas
authors.affiliation: 5 Division of Pulmonary and Critical Care Medicine and.|6 Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
mesh_terms: D062265:Health Insurance Exchanges / Q000331:legislation & jurisprudence*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D008393:Marriage / Q000331:legislation & jurisprudence*; D008484:Medicaid; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D011203:Poverty; D014481:United States
keywords: Medicaid; Patient Protection and Affordable Care Act; health insurance; health policy