Supreme Court focuses on ACA’s intent, not specific language

The ruling in King v. Burwell was just as Brian Pinheiro predicted.

Also see: The real lesson from SCOTUS subsidy decision

Not only was he correct in guessing the court would uphold subsidies to buy health insurance on the federally facilitated marketplace 6-3. The Ballard Spahr partner also called who would rule in favor of subsidies — Chief Justice John Roberts and Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan — and that Justices Antonin Scalia, Samuel Alito and Clarence Thomas would rule against them.

Pinheiro did have some help — he was in the courtroom during the March 4 oral arguments. Burwell’s position seemed to resonate more with the justices than that of the plaintiffs, Pinheiro says. “The government’s arguments were just stronger,” he says.

Also see: A view of King v. Burwell from inside the courtroom

Nearly all of the two-hour oral arguments focused on the whether the ACA intended to provide access to subsidies for the entire country, Pinheiro says. Just about every question the court had for the government was in that vein, he says, and was the focus of half of the questions for the plaintiffs.

The issue was the wording of the IRS rule that says individuals qualify for subsidies when they buy health insurance through an exchange “established by the state.” The plaintiffs, four residents of Virginia — which uses the federal exchange — argued individuals in FFM states could not use subsidies.

The Obama administration has said the law’s intent is to provide subsidies for everyone, not just those who purchased coverage through a state-based exchange. The court agreed.

“The court decided that it could not overturn the Affordable Care Act” and eliminate subsidies based on only those four words, Pinheiro says. The court instead looked at the ACA as a whole and determined its intent was to make subsidies available to the entire country, he says.

Also see: SCOTUS decision returns adviser focus to ACA compliance

In the majority opinion, Roberts admitted the ACA has flaws in its language, citing “more than a few examples of inartful drafting.” However, he wrote, the plaintiffs’ interpretation “would destabilize the individual insurance market in any state with a federal exchange, and likely create the very ‘death spirals’ that Congress designed the act to avoid.

“The combination of no tax credits and an ineffective coverage requirement could well push a state’s individual insurance market into a death spiral,” Roberts wrote. “It is implausible that Congress meant the act to operate in this manner.”

But that’s not what the law says, Scalia wrote in his dissent. “The act that Congress passed makes tax credits available only on an ‘exchange established by the state,’” he wrote. “This court, however, concludes that this limitation would prevent the rest of the act from working as well as hoped. So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare.”

Scalia continued: “Words no longer have meaning if an exchange that is not established by a state is ‘established by the state.’ It is hard to come up with a clearer way to limit tax credits to state exchanges than to use the words ‘established by the state.’”

Also see: Post-SCOTUS decision, advisers must focus on client impact

This marks the second time the Supreme Court ruled in favor of the health care law. In 2012, the high court ruled 5-4 to uphold the ACA — in National Federation of Independent Business v. Sebelius — a case that focused on a requirement for most Americans to get health coverage or pay a penalty. The individual mandate, as it’s referred to, went into effect Jan. 1, 2014.

There’s been much uncertainty surrounding the ACA since it became law, and this latest ruling affirms the health care law is here to stay, says Brydon DeWitt, partner at Williams Mullen. “Now the dust should finally settle,” he says. “This is the law and we have to comply.”