Surprise! The Supreme Court Just Saved the Affordable Care Act


The Supreme Court has smacked down a major challenge to the Affordable Care Act, one that could have caused millions of Americans to lose health insurance coverage. In a 6-3 decision, they ruled against the plaintiffs in King v. Burwell, who argued that the federal government couldn’t provide subsidies for health insurance in states that didn’t establish their own insurance exchanges.

Basically, the King plaintiffs argued that the ACA was worded to prevent subsidies in states that have federal marketplaces. If that argument had succeeded, the three dozens states who let the federal government run their health insurance marketplaces wouldn’t have been allowed to offer federal subsidies in those states, driving up the cost of healthcare and creating absolute havoc in the insurance market overall. The effects would have been tidal, colossal, enormous: whatever word you’d like to use to describe a giant shitshow. (The Kaiser Health Foundation did a good overview showing how much money in tax credits each state stood to lose; across the country, around 6.7 million people would’ve been affected, standing to lose about $1.7 billion in subsidies.)

As Mother Jones pointed out in a series of great features, the plaintiffs in the case were on shaky ground in their standing to sue in the first place, given that most of them weren’t actually “harmed” by Obamacare in the ways that they claimed. The four, all people from Virginia, were handpicked by the Competitive Enterprise Institute, a Libertarian think tank. As MoJo pointed out, their stake in the case was pretty questionable:

Three of the four plaintiffs are nearly eligible for Medicare, meaning their objections to Obamacare will soon be moot. Two of them appear to qualify for hardship exemptions—that is, they are not forced to acquire insurance or pay fines because even with a subsidy insurance would eat up too much of their incomes—so it’s unclear how Obamacare had burdened them. These two plaintiffs seemed driven by their political opposition to President Obama; one has called him the “anti-Christ” and said he won election by getting “his Muslim people to vote for him.” Yet most curious of all, one of the plaintiffs did not recall exactly how she’d been recruited for the case and seemed unaware of the possible consequences if she wins. Told that millions could lose their health coverage if the Supreme Court rules in her favor, she said that she didn’t want this to happen.

(Weirdly, the plaintiffs stayed almost completely out of sight for the duration of the case; lead plaintiff Douglas Hurst didn’t even speak at a press conference. His wife Pamela, who was not a plaintiff, did the talking.)

The decision ruling against them was written by Chief Justice John Roberts; you can read it in full here. Basically, he argued that the King plaintiffs were relying on misinterpreting the wording of the ACA to make it sound as though it didn’t allow the subsidies. In so many words, he said they were trying their damndest to sneakily undo what Congress had passed, and he wouldn’t allow it:

In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined—“to say what the law is.” Marbury v. Madison, 1 Cranch 137, 177 (1803). That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan. 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. Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt.

The three most conservative justices — Antonin Scalia, Clarence Thomas, and Samuel Alito — dissented, because of course they did. The dissent was written by Scalia (you can read it in the same document as the majority opinion, starting on page 27). He accuses his fellow justices of making a “feeble” argument to support their interpretation of the wording of the ACA, and of something called “interpretive jiggery-pokery.” In the end, he outright accuses Roberts and the majority justices of misinterpreting the law and ruling in the case unfairly solely so they can save the ACA, warning that their decision will echo in eternity:

Perhaps the Patient Protection and Affordable Care Act will attain the enduring status of the Social Security Act or the Taft-Hartley Act; perhaps not. But this Court’s two decisions on the Act will surely be remembered through the years. The somersaults of statutory interpretation they have performed (“penalty” means tax, “further [Medicaid] payments to the State” means only incremental Medicaid payments to the State, “established by the State” means not established by the State) will be cited by litigants endlessly, to the confusion of honest jurisprudence. And the cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.

Six million people aren’t losing healthcare coverage and Scalia is throwing a baby tantrum. It’s a great day.

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Pamela Hurst, wife of King v. Burwell plaintiff Douglas Hurst, speaks to reporters outside the Supreme Court in March. Photo via AP Images

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