They would then use the Senate reconciliation process to make a few minor tweaks with a 50-vote majority. The strategy worked, in terms of getting Obamacare passed as law. But as a consequence, the sloppy first draft of Obamacare that passed in the Senate in December 2009 became law, without any of the legal proofreading that would have taken place in a normal House-Senate conference. Among the consequences of the sloppiness were a Supreme Court case, King v. Burwell , which litigated the illegality of federal subsidies flowing to a federally-run insurance exchange (as opposed to exchanges that were directly set up by state governments). Obamacare’s cost-sharing subsidies in legal limbo Another piece of litigation, House of Representatives v. Price , involves the illegality of Obamacare cost-sharing reduction subsidies, or CSRs. CSRs are designed to subsidize deductibles and co-pays for lower-income individuals—those below 250 percent of the Federal Poverty Level—buying coverage on Obamacare’s exchanges. Without those subsidies, deductibles under Obamacare can exceed $6,000. The House of Representatives sued the Obama administration, noting that the statutory text of the Affordable Care Act talks a lot about cost-sharing subsidies, and requires insurers to design policies that assume the existence of cost-sharing subsidies, but never actually appropriates funding to dole out the subsidies.

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