Supreme Court Upholds Insurance Subsidies for All Americans

The state of healthcare in America became a little more secure today, as the Affordable Care Act survived its second Supreme Court case in the past three years.

The 6-3 ruling ensures Americans in all 50 states will continue to receive insurance premium subsidies under the Affordable Care Act.

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It’s a significant victory for the law, as President Barack Obama stated in his address at the White House following the decision.

“Today … after multiple challenges to this law before the Supreme Court, the Affordable Care Act is here to stay,” he said.

The Supreme Court case King v. Burwell hinged on whether those Americans who purchased insurance plans through the federal exchange were considered eligible for the same subsidies as those who purchased plans through individual state exchanges.

Chief Justice John Roberts wrote the opinion for the court, joined by frequent swing vote justice Anthony Kennedy and liberal justices Ruth Bader Ginsberg, Stephen Breyer, Sonia Sotomayor and Elen Kagan.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” he affirmed. “If at all possible, we must interpret the Act in a way that is consistent with the former and avoids the latter.”

As many as 34 states did not establish their own individual exchanges, and instead elected to use the federal exchange. Had the Supreme Court ruled in favor of the plaintiff, citizens in all of these states would have lost their subsidies and would likely no longer have been able to afford coverage.

The Department of Health and Human Services estimated about 6.4 million Americans would have lost subsidies if this were the court’s decision.

In the report, Roberts acknowledged the ambiguity of the law’s text overall, but stated that the court considered the broader intent of the law for the ultimate decision.

“The statutory scheme compels us to reject petitioner’s interpretation because it would destabilize the individual market in any State with a Federal Exchange, and likely create the very ‘death spirals’ that Congress designed the Act to avoid,” he wrote.

Justice Antonin Scalia wrote the dissenting opinion on the case. He asserted it was not the job of the Supreme Court to clarify or clean up Congress’s sloppy law drafting.

“Today’s interpretation is not merely unnatural; it is unheard of,” Scalia wrote. “Who would ever have dreamt that ‘Exchange established by the State’ means ‘Exchange established by the State or the Federal Government’?”

Even with this victory, though, the Affordable Care Act still faces many challenges in the future, including proposed legislative changes currently moving through Congress as well as other lawsuits currently in the lower courts.

However, some do think this decision will discourage judges from advancing cases for future Supreme Court consideration.

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“It sends a message to the lower courts that they need to take a good, hard look at all the ACA litigation that’s out there and probably clean up and get rid of most of it,” Timothy Jost, a law professor at Washington and Lee University and an expert on the health law, said to the Kaiser Family Foundation.

Overall, experts agree the decision is a step toward stability for healthcare in the U.S., but it does not mean the law is finished evolving.

Drew Altman, a columnist for the Wall Street Journal Think Tank, wrote his primary concerns following the decision.

“Significant challenges remain for the ACA, including: reaching those who are uninsured; stabilizing premium increases in the marketplaces as insurers get a better handle on risk pools; and determining which of the Medicare payment and delivery reform projects implemented under the ACA are working and should be scaled up,” he wrote.

So, the law continues to be a work in progress, a fact even President Obama does not deny.

“Let’s be clear, we’ve still got more work to do to make healthcare in America even better,” he said. “This was a good day for America. Let’s get back to work.”


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