{"id":69832,"date":"2015-06-26T12:22:22","date_gmt":"2015-06-26T16:22:22","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?p=69832"},"modified":"2024-02-23T17:10:17","modified_gmt":"2024-02-23T22:10:17","slug":"viewpoint-scotuscare-for-obamacare","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2015\/viewpoint-scotuscare-for-obamacare\/","title":{"rendered":"SCOTUScare for Obamacare"},"content":{"rendered":"\n
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June 26, 2015<\/div>\n\t\t\n\t\t\t\t
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\"viewpoint-scotus\"Viewpoint articles are written by members of the SPH community from a wide diversity of perspectives. The views expressed are solely those of the author and are not intended to represent the views of Boston University or the School of Public Health. We aspire to a culture where\u00a0all can express views in a context of civility and respect. Our guidance on the values that guide our commitment can be found at\u00a0Revisiting the Principles of Free and Inclusive Academic Speech<\/a>.<\/em><\/p>\n

A sigh of relief came from the White House and at least 6.4 million households Thursday morning when the US Supreme Court upheld federal tax credits for people who buy health insurance through the federal health insurance exchange. As President Obama said, the Affordable Care Act (ACA) is here to stay.<\/p>\n

Chief Justice Roberts wrote the decision for the majority of six Justices (Roberts, Kennedy, Ginsburg, Breyer, Sotomayor, and Kagan), once again saving President Obama\u2019s signature legislation. But, this time, the Court only needed to interpret the statute. This would be a rather ordinary task for the Justices, were it not for the enormous economic and political consequences hinging on the outcome.<\/p>\n

The King<\/em> plaintiffs argued that people who buy insurance on the federal exchange were not eligible for tax credits to help pay premiums because the ACA states that the credits are calculated on the basis of the premium of a plan purchased through \u201can Exchange established by the State.\u201d This would mean that people using the federal exchange would not receive tax credits, because their states have not \u201cestablished\u201d a state exchange. The plaintiffs were from Virginia, which uses the federal exchange. They did not want to buy health insurance or pay a penalty. If they were not entitled to tax credits, they would be exempt from the individual mandate (and penalty), because their premiums would exceed 8 percent of their incomes.<\/p>\n

The Chief Justice rejected this hyper-literal reading, writing, \u201cIt would be implausible that Congress meant the Act to operate in this manner.\u201d His opinion recognized that, absent the tax credits, not enough healthy people could afford to buy insurance, and insurers would have to raise premiums or drop out of the market\u2014defeating the Act\u2019s purpose. The Chief Justice wrote, \u201cCongress passed the Affordable Care Act to improve health insurance markets, not to destroy them.\u201d Admittedly, the opinion focused more on the survival of the insurance industry than on the need for access to health care. But since the ACA depends on private industry to cover millions of Americans who would not otherwise be able to pay for care, that distinction makes little difference. Finally, a majority of justices seem to understand the need for the \u201cinterlocking\u201d elements of health reform.<\/p>\n

The Court used an established rule of statutory interpretation to read the law\u2019s words \u201cin their context and with a view to their place in the overall statutory scheme.\u201d While it noted that the \u201cAct contains more than a few examples of inartful drafting,\u201d it sought \u201ca substantive effect that is compatible with the rest of the law.\u201d For this point, the Court cited its 2000 decision holding that that the FDA\u2019s first attempt to regulate cigarettes was not permitted by the Food, Drug and Cosmetic Act. (The public health community may find some irony in the fact that the principle that struck down tobacco regulation saved the ACA tax credits for people buying insurance through a federal exchange.) One could imagine Roberts inwardly grinning when, as support for his conclusion, he quoted Justice Scalia\u2019s own dissent in NFIB v. Sebelius<\/em>, which said, \u201cWithout the federal subsidies . . . the exchanges would not operate as Congress intended and may not operate at all.\u201d<\/p>\n

It is the Court\u2019s assumption of responsibility to interpret the ACA that is key to this decision. It means that even under a future administration, the IRS cannot redefine the meaning of \u201cestablished by a State.\u201d The Court agreed with the IRS interpretation of the disputed phrase, but found that interpretation was not the prerogative of the IRS. The majority held that Congress did not delegate interpretive authority to the IRS on this \u201cquestion of deep \u2018economic and political significance\u2019 that is central to this statutory scheme.\u201d Instead, it was the Court\u2019s responsibility to \u201cdetermine the correct reading\u201d of the text. Now, only Congress can change the result. And that seems unlikely in light of its repeated failure to agree on anything to \u201crepeal or replace\u201d Obamacare.<\/p>\n

Justice Scalia, who wrote a characteristically hyperbolic dissent, joined by Justices Thomas and Alito, calling the majority opinion \u201cjiggery pokery\u201d and \u201cpure applesauce,\u201d concluding, \u201cWe should start calling this law SCOTUScare.\u201d The Court did indeed insist on having the last word. But, in this case, the majority Justices acted more like a court of law than politicians.<\/p>\n

\"Wendy-Mariner1Cropped\"Wendy Mariner<\/a> is the Edward R. Utley Professor of Health Law.<\/em><\/span><\/p>","protected":false},"excerpt":{"rendered":"

The 6-3 ruling in King v. Burwell reveals the Court\u2019s growing understanding of health reform.<\/p>\n","protected":false},"author":8472,"featured_media":69834,"comment_status":"closed","ping_status":"closed","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"","_bu_prepress_primary_term_manual":"Viewpoint"},"tags":[1809,1751],"bu-publication":[3516],"sphnews-article-category":[3519,3545],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/69832"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/8472"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=69832"}],"version-history":[{"count":10,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/69832\/revisions"}],"predecessor-version":[{"id":237475,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/69832\/revisions\/237475"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/69834"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=69832"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=69832"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=69832"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=69832"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=69832"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=69832"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=69832"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=69832"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}