In a 6-3 decision released today, the U.S. Supreme Court upheld the availability of subsidies to health insurance purchasers on both state exchanges and the federal exchange, affirming the Fourth Circuit’s decision in King v. Burwell.
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Chief Justice John Roberts wrote for the majority. “If at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.”
Joining the Chief Justice were Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan. Justice Antonin Scalia wrote a dissenting opinion, joined by Justices Samuel Alito and Clarence Thomas.
Plaintiffs who brought the case contended that the language of the statute only authorized subsidies for purchasers on state-run exchanges, relying on language in the Act which appeared to limit subsidies to people buying insurance on “an exchange established by the state.”
North Carolina, like three dozen other states, did not set up its own health care exchange. More than 560,000 state residents purchased health insurance on the federal exchange instead, with more than 90 percent doing so with the help of subsidies designed to make coverage affordable for middle- and low-income purchasers.
The majority had plenty to say about the sloppiness of the drafting of the Act, but in the end found that the language at issue was ambiguous and could be interpreted in several ways. As such, the words should “be read in their context and with a view to their place in the overall statutory scheme.”
Scalia’s dissent was far less staid, calling the majority’s logic “jiggery-pokery” and “pure applesauce” and labeling the Act “SCOTUScare.”
“Under all the usual rules of interpretation, in short, the Government should lose this case,” Scalia wrote. “But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.”
Read the full court opinion here.