Industry insiders say the effects of two contradictory court rulings Tuesday on the legalityof subsidies under the Patient Protection andAffordable Care Act could have a long-term — and possiblydisastrous — effect on the law — but they’re also not counting onit happening quite yet.

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The often-controversial law suffered its latest blow Tuesdaywhen a U.S. appeals court ruled the government can’t give financialassistance to anyone buying coverage on the exchanges run by federalgovernment.

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The lawsuit — Halbig v. Burwell — targets a May 2012Internal Revenue Service rule that allows subsidies to be offeredthrough the federal exchange.

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The ruling is at odds with a separate appeals court decision inKing v. Burwell — which came hours later — that the IRShad the discretion to issue subsidies given “ambiguity”in PPACA’s language.

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The contradictory ruling means more confusion for consumers —and more guidance needed for those in the benefits business — justin time for the second open enrollment period under Obamacare,which begins Nov. 15. The two different rulings, industry insiderssay, also leads to a very good possibility the issue will head tothe Supreme Court.

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But so far, most say, they aren’t expecting the rulings —especially in the Halbig v. Burwell case — to be the endall, be all. The Obama administration already indicated they wouldappeal the D.C. appeals court ruling.

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Carrier group America’s Health Insurance Plans said carriers andbrokers should continue to stay the course, and not jump to anypremature conclusions or changes.

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“These issues typically take months or longer to be fullyresolved by the courts,” said AHIP spokesman Brendan Buck. “In themeantime, health plans remain focused on ensuring stability,affordability and accessibility for consumers.”

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The National Association of Health Underwriters similarly saidthat though the ruling poses “a profound long-term impact, itcauses no immediate market change.”

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“While this decision could eventually have huge ramificationsfor the health reform law, it is very important to note that theruling does not change anything regarding the distribution ofsubsidies or cost-sharing assistance, the operation of thefederally facilitated exchanges or enforcement of the employermandate for the time being,” said Jessica Waltman, NAHU’s seniorvice president of government affairs. “In making its ruling, theD.C. Circuit Court made a very specific decision not to immediatelyblock subsidies, acknowledging that their decision will be appealedright away.”

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Given that the federal exchange will remain fully operational,NAHU told brokers and agents they should “continue to work with[clients] to obtain coverage in the marketplace.” In doing so,Waltman said, they should relay information to their clients that:tax credit subsidies and cost-sharing assistance in both the stateand federally facilitated exchanges will continue to be distributedfor the time being; current clients with subsidized coverage areunaffected by the ruling; the individual and employer mandates arestill in place and open enrollment will continue as planned.

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And though some have speculated the case ruling will meanconsumers might even have to pay back the subsidies they alreadyreceived, Waltman said that likely will not be the case.

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“If the Supreme Court ultimately rules like the D.C. CircuitCourt and strikes subsidies moving forward, based on current legalprecedents, clients that currently have or will receive a subsidyin the future will likely not have to repay those subsidiesretroactively, assuming that the individual was legally eligiblefor the subsidy at the time of receipt,” she said.

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Still the fact that this doesn’t cause immediate changes in themarketplace didn’t stop others from speculating on what this maymean for the industry and for PPACA going forward.

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Steve Wojcik, vice president of public policy at the NationalBusiness Group on Health, said the uncertainty on the ruling isboth “a concern for part-time and full-time employees, retirees andfamily members of employees who qualify for subsidies, and foremployers that were relying on the public exchanges for coveragefor their employees.”

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Wojcik also said he thinks the ruling will most likely beappealed, so “this is not the end of the story.”

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state- and federal-based marketplacesOnly 14 states— California, Colorado, Connecticut, Hawaii,Kentucky, Maryland, Massachusetts, Minnesota, Nevada, NewYork, Oregon, Rhode Island, Vermont, Washington — and the Districtof Columbia opted to create their own exchanges in time for the2014 plan year, meaning that not allowing subsidies in the federalexchanges would have a huge impact on those consumers who rely onthem for affordable coverage.

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According to the Department of Health and Human Services, 5.4million people selected a health plan on the federal exchangeduring 2014 enrollment (out of 8 million enrollees all told). And85 percent of those consumers qualified for subsidies that reducedtheir premiums.

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Health consulting firm Avalere Health last week pointed to theimplications of finding subsidies illegal in the Halbig v.Burwell case, saying that nearly 5 million Americans would receive an average premiumincrease of 76 percent if the courts ultimately rulethat consumers in the federal exchange cannot receive premiumsubsidies.

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“The court case has major implications for future insurancecoverage and access to care for millions of Americans,” saidCaroline Pearson, vice president at Avalere Health. “Individuals inat least 25 states who remain in their current plans could see anaverage premium increase of over 70 percent.”

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