At 10 a.m. Wednesday, the Supreme Court will hold oral argumenton the latest legal challenge to the Affordable Care Act, the new federal health-care law. The oral arguments inKing v. Burwell will featuretwo high-profile lawyers, Michael A. Carvin of the Washington, D.C., law firm of Jones Day, for the challengers, and U.S. Solicitor General Donald B. Verrilli, Jr., defending the subsidy systemdesigned to help millions of consumersafford health insurance. The hearing is scheduled for one hour, but it may be allowed to run longer, especially since no other cases are up for argument that day.

Background

Five years ago, when Congress finishedwriting nearly athousand pages that would becomethe new national health-care law, it was well aware that the finished product would be subject to strong challenges. The Affordable Care Act was passed in both houses with not one Republican lawmaker voting for it. The day after it passed, Republicans introduced a bill to repeal it. The House has since voted some sixty times forrepeal.

Still, the law remains on the books, while controversy goes on,and the Supreme Court has now alloweditself back into the middle of the dispute, for the second time in three years.

Backers of the bill have always said it had three interlocking parts that were vital sometimes referred to as the three legs of a stool. The stool metaphor, they said, was apt: cut off any of the legs, and the thing would collapse.

One legwas not controversial with many people:insurance companiescouldno longer deny coverage or hike premiums just because a person had existingproblems heart disease, for example or a past history of such problems. Insurers, though, were heavily involved in writing the new law, and they were being assured a nationwide pool of customers for their business.

Another leg, to insure that there would be that nationwide pool, was a mandate that every individual in the country would have to buy health insurance or else pay a financial penalty with their tax return. That was the leg that challengers singled out three years ago, but a Supreme Court majority found a way to reinforce that leg constitutionally.

The third leg the one now under challenge in the Court created a system of tax credits, or subsidies, to enable middle- or lower-income people to afford health insurance. It would be available to individuals who did not have coverage through their jobs, and could not qualify for Medicare or Medicaid. They would shop for insurance on marketplaces (formally, exchanges) set up in every state, offeringa smorgasbord of supposedly affordable insurance plans.

If that leg is cut off, the supporters of the ACA have always argued, it would set off a death spiral death, here, in an economic sense. Unable to afford health insurance without a subsidy, millions of healthy people would lose their policies, and the shrinking of the healthy consumer pool would lead insurance companies to escalate premium prices spiraling into the death of the ACA.

The size of that threat may already be clear: in the latest sign-up period for health insurance under ACA, some 11.2 million Americans sought coverage, and eighty-sevenpercent of them did so with the support of a subsidy.

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Argument preview: Now, the third leg of the health-care stool