This week, the U.S. Supreme Court’s ruling in King v. Burwell—the case that threatened subsidies offered under the Affordable Care Act—dominated the headlines in healthcare.
In a 6-3 decision, the court upheld the subsidies nationwide, despite a legal challenge that argued the law specifically allows for subsidies to be used only for insurance purchased on exchanges established by states, not the federal government.
The ruling likely saved the eligibility of subsidies for more than 6 million people currently served by the federal exchange, and heads off what would have been a contentious debate in Congress over how to fix the language.
Since we don’t have to worry about that, though, let’s take a look at some of the top quotes from the majority and dissenting opinions. Writing for the majority, Chief Justice John Roberts outlined why the quirks in wording shouldn’t undermine the spirit of the law. Meanwhile, the dissent authored by Justice Antonin Scalia harshly criticized the reasoning of the majority—and whatever your personal opinion is on the matter, you’ve got to admit Scalia has a way with words.
From the majority:
- “The Affordable Care Act contains more than a few examples of inartful drafting.”
- “Here, the statutory scheme compels the Court to reject petitioners’ interpretation because it 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.”
- “When read in context, the phrase ‘an Exchange established by the State’…is properly viewed as ambiguous. The phrase may be limited in its reach to State Exchanges. But it could also refer to all Exchanges—both State and Federal—for purposes of the tax credits.”
- “A fair reading of legislation demands a fair understanding of the legislative plan.”
- “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”
From the dissent:
- “Pure applesauce.”
- “Words no longer have meaning if an Exchange that is not established by a State is ‘established by the State.’”
- “The Court’s next bit of interpretive jiggery-pokery involves other parts of the Act that purportedly presuppose the availability of tax credits on both federal and state Exchanges.”
- “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.”
- “We should start calling this law SCOTUScare.”
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Editor – Health Imaging