Supreme Court Upholds Affordable Care Act

In a landmark 6 to 3 vote, the US Supreme Court has upheld a pivotal provision of the Patient Protection and Affordable Care Act (PPACA) that provides subsidies to individuals in the federally facilitated marketplace. The ruling against the plaintiff in the case of King v. Burwellwas similar toNFIB v. Sebelius, which concluded with a redefinition of the language in the ambiguous bill by Chief Justice Roberts.

In 2014, approximately 87% of individuals who purchased insurance on a Federal Exchange did so with the help of a tax credit. Without these programs, individual insurance markets could not function, the Court noted. Without the credit, the Court speculated that premiums would increase by 35% and that enrollment would decrease by 69%.

"When the dust has settled, there can be no doubt that this law is working. As the law's provisions have gradually taken effect, more than 16 million Americans have gained coverage so far," said President Barack Obama, who championed the bill. "This is not a set of political talking points. This is reality. This law is working. Across the country, there are people who are directly benefiting from the law and don't even know it."

The 6 justices who voted against the plaintiff were Chief Justice Roberts and Justices Anthony Kennedy, Ruth Bader Ginsburg, Steven Breyer, Sonia Sotomayor, and Elena Kagan. Justice Antonin Scalia, Justices Clarence Thomas, and Samuel Alito opposed the decision.

In a document defining the opinion of the Court, the language in the bill was labeled ambiguous and needing of further definition in order to be clearer. Rather than throw the bill out entirely, the Court decided to provide clarity on the true meaning behind the ambiguous text, based on contextual clues in the rest of the document.

"Congress passed much of the Act using a complicated budgetary procedure known as 'reconciliation,' which limited opportunities for debate and amendment, and bypassed the Senate’s normal 60-vote filibuster requirement,” said the opinion document written by Chief Justice Roberts. “As a result, the Act does not reflect the type of care and deliberation that one might expect of such significant legislation. Given that the text is ambiguous, we must turn to the broader structure of the Act to determine the meaning."

In a heated explanation of the dissenting view, Justice Scalia wrote, "Under all the usual rules of interpretation, in short, the Government should lose this case. But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved."

Following the vote, President Barack Obama, who championed the bill early in his presidency, said, "The Affordable Care Act is here to stay."

However, Republicans in the House and the Senate had a far different view on the Court's ruling. Following the decision onKing v. Burwell, US Senator John Thune from South Dakota said:

“Obamacare continues to be a disaster for many American families and businesses. Under this law, Americans will continue to pay higher premiums, face an avalanche of regulations, and cope with the loss of their preferred doctors," Thune said. "Obamacare’s ‘top-down’ approach to health care has forced Americans off plans that they liked, hurt job creation, and reduced choices of doctors and hospitals."

Given the admittedly ambiguous nature of the PPACA, future lawsuits seem more than likely. However, following decisions handed down to-date, the outcome seems in favor of the bill. Despite this, Thune noted confidence in an eventual repeal. Additionally, several potential Republican Presidential candidates noted their disappointment in the decision.

"The Republican-led Senate remains committed to repealing this fundamentally broken law and replacing it with patient-centered reforms that work for the American people,” Thune said.