On Thursday, June 25, the Supreme Court released its decision in King v. Burwell, the latest case challenging the Affordable Care Act (ACA). At issue was whether subsidies can be extended to low-income people who live in the 34 states that have federally facilitated, rather than state-based, marketplaces. The plaintiffs argued that Congress wrote the ACA in a way that only people who live in states with state-based marketplaces should receive subsidies, which would have jeopardized assistance for more than 6 million Americans currently receiving subsidies. In a 6-3 ruling drafted by Chief Justice Roberts, the Supreme Court upheld the subsidies and kept the ACA intact. People who live in states using www.healthcare.gov for their marketplace can continue to receive subsidies.
Besides answering the immediate question about subsidies, the decision more broadly defends the current implementation of the ACA and will make it more difficult for other cases to successfully challenge the law. This is because the decision says that ambiguous aspects of the ACA must be interpreted through the lens of Congress’ intent for the ACA to improve the health insurance market. The decision even makes it more difficult for future administrations to remove subsidies from these states. The decision concludes with this remarkable 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.”
Policymakers in Washington and statehouses across the country have been drafting various contingency plans anticipating that subsidies may be struck down. Many plans would have traded extended subsidies for other reforms to the ACA, such as elimination of the individual mandate or other insurance policies. While Congress is likely to continue to consider bills to repeal part or all of the ACA and state policymakers will continue to influence ACA implementation in their states, today’s decision means that the ACA is likely to continue as is for the near future.
