King vs. Burwell decision lingers, glimpses emerge

It was almost King vs. Burwell day. It was almost the day the U.S. Supreme Court issued a ruling on the future of health insurance tax credits.

The health care community on Twitter Wednesday night was aflutter with sound-byte commentary and links to previews, predictions and what-ifs.

But then it wasn't.

The case, which questions whether tax credits are available on both state- and federally run exchanges, has been at the forefront for months: a nebula of uncertainty and anticipation. The plaintiffs argue language in the Affordable Care Act means tax credits, which make health insurance affordable for millions, are available only on state-run exchanges.

Oral arguments were heard March 4. A decision will come three-and-a-half months later, more in line with initial forecasts of late June. The timeline is longer even than the seemingly endless NBA playoffs, which concluded Tuesday.

For those who have an interest in the future of tax credits and make a hobby of following the Warriors or Cavaliers, it could have been a long few months.

This week, Warriors fans got a trophy, Cavs fans got closure, and King vs. Burwell watchers got, well, a delay.

The Supreme Court decided to issue some decisions on Thursday, a move it sometimes makes when decision Mondays in June get jammed. It issued six Thursday and there are 11 remaining, King vs. Burwell among them.

Thursday was, however, a bit of a dry run.

The industry got a taste of what could happen when the ruling comes, particularly if it's for the plaintiffs.

The stocks for locally based Community Health Systems, HCA and LifePoint Health took a bit of a tumble around the time decisions were set to come out.

The declines weren't earth-shattering, small dings for hospital operator giants -- some of which list the case as a risk factor in financial filings -- but it offered a glimpse into how closely investors, and many others, are watching SCOTUS for signs about the near-term health of the health care industry.

With a ruling for "the plaintiff, King, we could find a short-term drop in health care stocks. The for-profit providers and health insurers? (The exchanges have) been good for them," said Fletcher Lance, managing director at consulting firm North Highland. "This could be a short-term blip."

The ruling for Team King may have an immediate impact on stock prices of health care companies, but its long-term implications could reverberate far beyond those who invest in stocks or even those who receive tax credits.

"It may not impact you directly, but it's going to impact everyone indirectly. Those marketplaces are key to having a fair and just health system that helps those of modest needs get covered," said Peter Leibold, chief advocacy officer for Ascension Health. "Some will see those 6.4 million (who have subsidies) and feel bad for those 6.4 million -- but it will reverberate."

A recent poll by Kaiser indicates that 60 percent of Americans haven't heard of or know very little about the case.

"I hope it stays positively unknown tor the vast majority of Americans," Leibold said. "I hope they have to never know what King vs. Burwell means."

The nature of a ruling for the plaintiff and actions taken by Congress or state governments will determine to what degree Americans feel the ruling.

Gov. Bill Haslam has said Tennessee is taking a "wait and see" approach to evaluating a state-run exchange. There are 182,893 Tennesseans enrolled in insurance on the exchange; 155,753 receive a tax credit that averages $218.

If Congress passes a one-line bill to make credits available on the federally run exchange, as Leibold hopes, the impact could be lesser.

If a political stalemate arises, then the Affordable Care Act and health reform could again dominate the national agenda. For some that's opportunity, for others it's a headache. For others still, it's a crisis.

James F. Blumstein, University Professor at Vanderbilt University, sees the opportunity for lawmakers, particularly those from Tennessee, to make a stamp on health care reform, and perhaps prevent the destabilization that HCA forecasts would happen.

"I think the opportunity, though, is to learn, evaluate and (for Tennessee to) be a fast follower," Lance said. "Could this be a catalyst to move it forward? There is a lot of uncertainty, and it's hard to make crisp decisions in uncertainty."

Holly Fletcher can be reached at 615-259-8287 or on Twitter @hollyfletcher.