Supreme Court Deals Final Death Blow to Republicans over Obamacare

In a 6-3 majority decision, the Supreme Court upheld the constitutionality of the federal health insurance subsidies under the Affordable Care Act that are currently being received by an estimated 6.4 million who live in states with Federally-run insurance exchanges. Most revealing was the short and curt decision, written by one of the court’s staunchest conservatives, Chief Justice John Roberts:

“Congress passed the Affordable Care Act to improve health insurance markets, not destroy them,” Robertswrote.  With that, the court was in essence telling Republicans to give it a rest already.

At issue in the case were four little words, which, it turns out were no more than a stenographic erroraccording to the bill’s authors.The phrase at issue in the case was a line in the bill, which read that the federal government can provide subsidies for exchange plans “established by [a] State.” This rendered into question whether the 36 exchanges operated by the federal government can still be considered established by the states.

With this decision, the Court refused to apply the “Chevron deference”–that is, to find that the statute is ambiguous. Instead the court ruled that the federal government’s interpretation of these four little words was reasonable.

However, the protection of markets, rather than the protection of health care rights may have been more at the heart of the decision. Later in his opinion, Chief Justice John Roberts explained that “the combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner.”

The death spiral referenced by Roberts can occur in insurance markets when costs rise rapidly as a result of changes in the covered population, for instance, when the young and healthy disproportionately drop coverage leaving the more expensive sicker, older populations insured. The concern by the court was that as a result of losing their subsidies, young healthy people would choose to face a relatively small tax penalty rather than shell out the high sums of money it would cost to get insurance on the individual market without subsidies. Insurance companies who braced for this possible scenario can breathe a sigh of relief.

Regardless of its reasons, with this ruling the court protected subsidies to millions of Americans and dealt what is hopefully a final “death blow” to Republican attacks on the law.