For the second time in three years, U.S. Supreme Court Chief Justice John Roberts has saved the Affordable Care Act (ACA–Obamacare) from a constitutional challenge.
This time, in King v Burwell, he was joined by Justice Anthony Kennedy.
The challengers said the law only allowed insurance subsidies to people enrolled in a healthcare exchange established by the “State.” The defenders of the law said the subsidies apply to all enrolled in a state or the federal exchange and the word “State” must be read in context.
Writing for a 6-3 majority, Roberts said the ACA contains “more than a few examples of inartful drafting, ” and the phrase “an Exchange established by the State under [42 U. S. C. §18031]” is properly viewed as “ambiguous.”
Roberts Highlights
Here are excerpts from Robert’s 21-page opinion:
But often-times the meaning—or ambiguity—of certain words or phrases may only become evident when placed in context.
The argument that the phrase “established by the State” would be superfluous if Congress meant to extend tax credits to both State and Federal Exchanges is unpersuasive…the statutory scheme compels the Court to reject petitioners’ interpretation because it would destabilize the individual insurance market in any State with a Federal Exchange, and likely create the very “death spirals” that Congress designed the Act to avoid
The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner. Congress made the guaranteed issue and community rating requirements applicable in every State in the Nation, but those requirements only work when combined with the coverage requirement and tax credits. It thus stands to reason that Congress meant for those provisions to apply in every State as well.
Petitioners’ plain-meaning arguments are strong, but the Act’s context and structure compel the conclusion that Section 36B allows tax credits for insurance purchased on any Exchange created under the Act. Those credits are necessary for the Federal Exchanges to function like their State Exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid.
Had Congress meant to limit tax credits to State Exchanges, it likely would have done so in the definition of “applicable taxpayer” or in some other prominent manner. It would not have used such a winding path of connect-the-dots provisions about the amount of the credit.
Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.
Scalia and “SCOTUScare”
But the best lines of the 47-page decision belonged to Justice Antonin Scalia, who wrote the dissenting opinion and took no prisoners.
He said the Court’s holding that when the ACA says “Exchange established by the State” it means “Exchange established by the State or the Federal Government…is of course quite absurd, and the Court’s 21 pages of explanation make it no less so.”
“Under all the usual rules of interpretation, in short, the Government should lose this case. But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.”
The best line of the day was Scalia’s, writing that his brethren on the Court “rewrote” the law to make the tax credits available everywhere. “We should start calling this law SCOTUScare, ” concluded Scalia.”
Horse Is Out of the Barn
The Court has now ruled the mandate requiring people to purchase health insurance is constitutional and the tax subsidies to help pay for individual premiums are what Congress intended. While there is never an end to legal challenges for any law, we don’t see anything on the horizon to seriously challenge Obamacare.
The only route left for those bent on overturning the law is through legislation and a president willing to sign a repeal of the ACA into law. That’s why we have elections. Polls overwhelmingly show that Americans have come to like their subsidies paid for with their tax dollars, fees on providers and changes to Medicare payments.
To read the entire decision yourself, click here. It’s a great history of the law.
