In a huge win for the Obama administration and a equally huge relief for the millions of Americans who now rely on federal subsidies to pay for the health insurance they are required to carry by the Affordable Care Act, the Supreme Court on Thursday morning ruled that subsidies to help pay for insurance are legally available to citizens of all 50 states.
The 6-3 ruling was written by John Roberts, the Republican-appointed Chief Justice who once before stepped in to protect the ACA, also known as Obamacare, from critics who claim that it is illegal.
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The case before the court, King v. Burwell, hinged on the question of whether citizens in states that did not establish health care exchanges on which insurers could sell ACA-compliant plans, were eligible for subsidies. The issue arose because of a single line in the massive law that suggested subsidies might only be payable to policies purchased through an exchange “established by the state.”
A ruling striking down subsidies to citizens in the 34 states that rely on the federal exchanges would have caused massive disruption in the healthcare markets, while depriving up to 8.2 million people of their insurance.
The argument that Congress would not have purposefully implanted a requirement in the law that would devastate the healthcare marketplace was central to the decision, which was joined by Justices Anthony Kennedy, Ruth Ginsburg,Stephen Breyer, Sonia Sotomayor, and Elena Kagan.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.
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In a blistering dissent, Justice Antonin Scalia called the majority’s ruling “absurd.”
“The Court holds that when the Patient Protection and Affordable Care Act says ‘Exchange established by the State” it means “Exchange established by the State or the Federal Government.’ That is of course quite absurd, and the Court’s 21 pages of explanation make it no less so.”
The dissent, which was joined by Justices Clarence Thomas and Samuel Alito, continued, “Words no longer have meaning if an Exchange that is not established by a State is ‘established by the State.’ It is hard to come up with a clearer way to limit tax credits to state Exchanges than to use the words “established by the State.” And it is hard to come up with a reason to include the words ‘by the State’ other than the purpose of limiting credits to state Exchanges.”
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