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By Noam N. Levey, Tribune Washington Bureau (TNS)

WASHINGTON — The U.S. Supreme Court is hearing oral arguments Wednesday morning in the latest legal challenge to the Affordable Care Act, a lawsuit that threatens to strip away federal insurance subsidies from millions of Americans and critically undermine the law’s program for expanding health coverage nationwide.

The challenge – spearheaded by conservative and libertarian activists in Washington – was once considered a legal long shot. The architects of the health law, as well as many legal experts and state officials nationwide, have widely rejected the challengers’ interpretation of the law.

But the outcome of King vs. Burwell, as the case is called, is now in doubt, as four conservative justices on the court have made no secret of their hostility toward the sweeping health law President Barack Obama signed five years ago.

In 2012, these justices fell one vote short of overturning the whole law, when Chief Justice John G. Roberts Jr. joined the four left-leaning members of the court to uphold the law’s requirement that Americans have health insurance.

All eyes will be on Roberts, who came under fierce attack from conservatives three years ago for sparing a law that has animated Republican politics since it was enacted.

The current challenge argues that a strict reading of the statute makes health insurance subsidies available only in a handful states that established their own insurance marketplaces through the law.

Thirty-seven states elected instead to have the federal government fully or partially operate their marketplaces using the HealthCare.gov website.

The marketplaces, a central pillar of the law, allow Americans who don’t get health benefits at work to shop online among plans that must offer basic benefits and cannot turn away customers, even if they’re sick.

Consumers making less than four times the federal poverty level – about $47,000 for a single person or $97,000 for a family of four – qualify for subsidies to offset the cost of their premiums.

Those subsidies are considered essential to the marketplaces because they allow healthy people to buy coverage, offsetting the costs of sick consumers.

If the challengers prevail, an estimated 7 million people could lose access to the insurance aid, likely causing widespread disruptions to insurance markets nationwide.

Arguing for the challengers is Michael A. Carvin, a former Reagan administration lawyer who also represented some of the challengers in the 2012 lawsuit against the Affordable Care Act.

He will face the justices for the first 30 minutes of arguments Wednesday morning.

Carvin will be followed by U.S. Solicitor Gen. Donald Verelli Jr., who will defend the law on behalf of the Obama administration.

Verelli was widely criticized for his performance in the health care case before the court three years ago. But he was ultimately vindicated when the court upheld the law.

Photo: SEIU International via Flickr

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