SCOTUS delivers a win for health insurance subsidies in 32 states

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The Supreme Court has ruled in favor of the federal government in King v Burwell, effectively keeping the Affordable Care Act intact without changes.

In the final days of its session for the year, the court ruled in favor, 6-3, of the argument made by Virginia resident David King and his co-plaintiffs, who said the 32 states which chose to have the federal government set up health exchanges for them are not eligible for federal insurance subsidies.

The court ruled to protect the subsidies because "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," according to the ruling.


But the justices added that "The Affordable Care Act contains more than a few examples of inartful drafting," criticizing the inexact wording that lead to the case coming before the Supreme Court.

The six justices who voted to keep the subsidies were Chief Justice Roberts, Kennedy, Ginsburg, Breyer, Sotomayor, and Kagan. The court found that the law is not ambiguous, and that the federal government's intent in writing it was clear and reasonable.

The dissenting justices were Scalia, Thomas and Alito.

"We should start calling this law SCOTUScare," Alito wrote in his dissent.

The argument was based on the specific wording of section 1311 of the Act which explicitly says that state-run insurance exchanges qualify for a tax rebate. They argued that this means federally-run exchanges (which make up two-thirds of the nation's exchanges) can't get the rebate.


Justice Antonin Scalia said in his dissenting opinion "Words no longer have meaning if an Exchange that is not established by a State is “established by the State.”

In the 32 states with federally run exchanges, a study from the Urban Institute found, there are 8.2 million people relying on the subsidies to afford health insurance.


Republicans have been waiting for an opportunity to take down—or at least heavily change—the Affordable Care Act. This decision is unlikely to mean those efforts will die, although it strengthens the Act's position, especially as public insurance networks become better-established across the country.

But as the Washington and Lee University law professor Timothy Jost notes, there are still about a dozen other lawsuits against parts of the ACA across the country underwayJost says that given the court's decision in King v Burwell, the courts in those cases are more likely to rule to protect the Affordable Care Act moving forward.


Read our explainer on King v Burwell here.