Health Center State Policy

Victory for the ACA: Moving Forward after King v. Burwell

King v. Burwell — Image Credit Ted Eytan

The King v. Burwell Supreme Court decision on Thursday marked a huge victory for ACA proponents. In a 6 -3 ruling, SCOTUS upheld health insurance premiums for eligible individuals in all states—regardless of whether their marketplaces were state or federally-established. The decision was met with both relief and applause by President Obama’s administration. With Congress still without a contingency plan as of Thursday morning, the ruling in favor of Burwell likely saved policymakers from months of legislative chaos, while also preserving health insurance for over 6 million Americans.

With the wait finally over, we are now left to consider what the Court’s recent decision means for the ACA moving forward. This is the last in a series of posts that have examined the case’s details and possible implications leading up to last Thursday’s big decision.

Breaking down the majority opinion

Chief Justice Roberts, joined by Justices Kennedy, Breyer, Ginsburg, Kagan, and Sotomayor, read the opinion confirming the legality of health insurance subsidies across all 50 states. Prior to the decision, many believed the ruling would be decided on the Chevron rule—or namely whether the federal agency (IRS in this case) had made a reasonable interpretation of the statute at hand. Instead, the Court announced the IRS was no health insurance expert and the Court, rather than the IRS, should determine the “correct reading” of the law.

The Court concluded the phrase underlying the whole case, “established by a state,” was indeed ambiguous. However, when read in relation to the ACA as a whole, the Court determined the underlying purpose of the law relied too heavily on the availability of subsidies across all marketplaces for “marketplaces” to be interpreted as solely those “established by a state.” In the majority’s opinion, limiting subsidies to only state-established marketplaces would undermine the entire healthcare system—something Congress would never have intended to do. Chief Justice Roberts synthesized these ideas in his concluding statement:

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.

Understanding the dissent

In a heated dissent, Justice Scalia, on behalf of himself, Justice Thomas, and Justice Alito, declared the Court’s majority decision as “interpretive jiggery-pokery” that omits the plain meaning interpretation of “established by a state.” Justice Scalia accuses the majority of once again rewriting the ACA to save it from its demise. As stated by Justice Scalia, the “opinion changes the usual rules of statutory interpretation for the sake of the Affordable Care Act. That, alas, is not a novelty.”

The dissent goes on to dismiss each of the points presented in the majority opinion; however, the opinions of Justice Scalia are perhaps best be summed up by his new nickname for the ACA: “SCOTUScare.”

What’s next for the ACA?

While the King v. Burwell ruling does not safeguard the ACA from additional legal attacks, it sets the precedent that the ACA is here to stay—at least through the end of President Obama’s second term. The ruling supports Congress’s intent to improve, not hurt, insurance marketplaces with the ACA—making similar court litigation unlikely in the future.

Although some fear the decision for Burwell may discourage states from establishing their own State-based marketplaces, HHS Secretary Burwell has vowed to continue to offer assistance to states wishing to shift towards a State-based marketplace. Burwell admits the administration still “has work to do” to make the ACA better, but remains optimistic on the administration’s chance to “build on the progress” the ACA has made. Following the decision, Burwell announced several new campaigns to improve the law, including a push to expand Medicaid in non-expansion states and reforms to payment systems to reflect quality not quantity of care.

Though the complete repeal of the ACA is unlikely at this point, the topic is almost guaranteed to resurface during the 2016 presidential campaign season. Although the ACA could take a beating during the upcoming race, President Obama remains confident in the future of his signature legislation. In a press conference on Thursday, President Obama heralded the decision remarking that “after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all.” In his own words, it is becoming increasing clearer that “the Affordable Care Act is here to stay.”