Every President of the United States has had some sort of legacy that marked their time in office. For Lincoln, it was the Emancipation Proclamation. For Roosevelt, there was the New Deal and victory in World War II. And for Kennedy, it was the country’s first space exploration. Will Obamacare be the legacy that defines the sitting president’s administration? The Supreme Court will make a decision this week with the King v. Burwell case.
The issue being debated in King v. Burwell ultimately traces back to the context of the Affordable Care Act, which established federally-run and state-based insurance exchanges. In Obamacare’s first year, fourteen states and the District of Columbia decided to set up state-based markets, while the other 36 states opted for a federally-run market using Healthcare.gov.
Section 1311 of the Affordable Care Act states that federal subsidies are to be given to states with their own insurance exchange. The plaintiffs explained that the reason behind this policy was to motivate states to set up their own insurance markets, but in reality, it has caused intense controversy between the federal and state government-one that could possibly threaten the existence of Obamacare.
In King v. Burwell, the federal government’s primary defense lies in the interpretation of one single word written in the part of the Affordable Care Act that creates federally-facilitated exchanges. It says that for every state that does not create its own insurance exchange, the federal government will intervene and “shall establish and operate such exchange.” The word “such” suggests that the federal-run market is to be seen as equivalent to that of the states, so states using Healthcare.gov should be entitled to the same subsidies as the states that do not.
The federal government proceeded to argue that the clause that institutes the federal insurance exchange should not be examined in solitude but rather in a larger picture. The goal of the Affordable Care Act, after all, is to help give states affordable health insurance, so the notion that states using Healthcare.gov are not allowed federal subsidies defeats the entire goal of the health care reform.
“No sentient following the health care debate could argue, in good faith, that Obamacare’s architects intended for the federal government to set up exchanges without subsidies,” said Jonathan Cohn, a political journalist for The New Republic. “It would completely subvert the law’s intent.”
The federal government also pointed to the part of the bill that says people who “reside in the State that established the Exchange” can purchase health insurance. Taken literally, this would denote that citizens from states that use federal markets cannot buy insurance—something completely absurd.
At the most, the Affordable Care Act is vague, and when any law is vague, the courts will rule in favor of the interpretation made by the agency that wrote the law. The federal government thus has the power to say that all states, whether those using federal or state facilitated markets, are eligible for subsidies.
“There was not a breath during the legislative debate suggesting that Congress meant to deprive citizens in states with federally-facilitated exchanges of tax credits,” said Nicholas Bagley, a law professor at the University of Michigan.
The Affordable Care Act, although far from being perfect, is not a bad idea. Under the law, citizens will see a more affordable health care system, which will ultimately reduce tax spending on poor overall health and premature death.
“We know that the act will help all people be more engaged to make better, more informed health decisions, and that’s a good thing,” said Leslie Kelly Hall, senior vice president of policy at Healthwise.
I, along with many other Americans, look forward to the Supreme Court declaring the federal government as the victor in this legal battle.
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Two problems with the above, both factual:
1) According to Jonathan Gruber, one the the principal architects (according to sentients such a President Obama and majority Leader Nancy Pelosi) of the ACA, the law was intended to motivate states to found exchanges by penalizing them if they didn’t.
2) The following statement, “There was not a breath during the legislative debate suggesting that Congress meant to deprive citizens in states with federally-facilitated exchanges of tax credits” is, at best disingenuous. Nearly half of the members of congress never saw the text of the ACA statute until it was passed by the Democrats and most of those Democrats never bothered to read the legislation carefully.