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In a crazy, but dramatic style, two U.S. appeals courts issued contradictory rulings on health exchange subsidies within hours of each other.  The first dealt a huge blow to the president’s health law by striking subsidies down for millions of Americans covered through HealthCare.gov, the Federal Exchange.  In effect, crippling the law.  The second court ruling, a couple of hours later, sided in an opposite manner.  

No subsidies were cut off immediately as the legal fight will continue.

At issue is whether individuals can get subsidies to help make insurance affordable in both federal and state exchanges. The first ruling determined that the IRS acted beyond its authority in providing the tax credit, and that instead it should only be done under the authority of a state.  This holding would eliminate all subsidies provided in the 34 Federal Exchanges, making the insurance mandate not affordable for millions.  

Another three-judge panel of the U.S. Court of Appeals ruled a short time later that the IRS correctly determined that subsidies, or tax credits, can flow through all Federal Exchanges despite unclear wording in the Affordable Care Act.

The cases are among several lawsuits in which individuals or state officials are challenging the Obama administration’s authority to grant subsidies in the form of tax credits to low and middle-income Americans buying health coverage through the federal-run exchanges.  Because two federal appeals courts have acted in a completely opposite manner, this nearly guarantees review by the Supreme Court.

At risk are millions of rural patients, who disproportionately qualify for Federal Exchange subsidies.  Anyone who qualifies for the federal tax credit better hold on...this ride will definitely not be short.