|Type of paper:||Case study|
|Categories:||Court system Justice Healthcare policy|
Though meant to improve the insurance coverage among Americans, especially the low and middle-income citizens, and hence enhance access to universal healthcare, Patient Protection and Affordable Care Act (ACA) ended up greatly dividing the country. This is the reason why the King V. Burwell decision, made by the Supreme Court of the United States in 2015 was such a monumental decision. It interpreted the provisions of the ACA.
The lawsuit that led to the ruling was first filed Eastern District of Virginia. The plaintiffs argued that the ACA authorizes tax credits just for individuals purchasing insurance on state-established Exchanges. However, the District Court rejected their arguments, and the case was dismissed. The decision was then appealed at the United States Court of Appeals. It was held that according to the regulations of the IRS, tax credits and subsidies are accessible both to those purchasing health insurance through the Federally-facilitated Exchange as well as those purchasing insurance through the State Exchanges. At this point, the plaintiffs asked the Supreme Court of the United States to hear the case, and the court agreed. On the 25th of June 2015, in a 6-3 ruling, the arguments by the challengers of ACA were rejected. This paper seeks to discuss the opinions of the court regarding the ruling with a deeper focus on the opinion of the Chief Justice. The effect of the decision on the uninsured population as well as on Medicaid will also be discussed.
Opinions of the Court
In the court's opinion, which was read by Chief Justice Roberts, the court held that tax credits are only available to the citizens in states where the federally-facilitated Exchange is utilized. Chief Justice Roberts also argued that the phrase "an Exchange established by the State' is ambiguous about tax credits. The Court, therefore, had to look at the broader structure and text of the Act to find out the meaning of the phrase. The court ruled that considering the text of the ACA as a whole, every state must provide tax credits to all its qualifying citizens. The court held that any other interpretation of the Act would interfere with the reforms that the Congress had put in place to achieve affordable healthcare for all citizens. The interpretation affirmed the position held by the state governments as well as members of the Congress since the inception of the Act. Therefore, according to the ruling, tax credits should be availed to all eligible citizens regardless of whether the Exchange is run by the state or the federal government (CONSTITUTIONAL ACCOUNTABILITY CENTER, 2019).
The ruling was received differently by different parties. The conservatives felt that the justices of the Supreme Court acted as lawmakers rather than the judges. They argued that by siding with the administration, they allowed the executive to engage in more bad practices. They also the ruling could bear broader implications for future laws attempting to curb the excessive presidential power. According to the conservatives, though the Supreme Court had been called upon to check the limits between the executive and the Congress in King v. Burwell, most of the justices chose to save Obamacare (Slattery, 2015).
The Opinion of the Chief Justice
Regardless of the position held by various parties, the Chief Justice was clear and persuasive in his explanation of the ambiguity in the Act. The plaintiffs in the lawsuit had argued that the Act would cause a death spiral. However, by pointing out the ambiguity in the text of the Act, the Chief Justice together with the majority of the court showed that that was not the outcome intended by the Congress (Rosenbaum, 2015). Moreover, the Chief Justice clearly showed that it was not the role of the court to determine the intention of the Congress. The court's role was to apply the Act as it is written. The dissenting justices also had a similar opinion. They argued that the law should be applied as it is written. Therefore, it would be wrong to state that the Chief Justice was more concerned with the survival of Obamacare than the interpretation of the law, as advanced by some conservatives. On the contrary, the lawsuit and the subsequent ruling was about the elements that make a law ambiguous and how courts should interpret statutory language (Lempert, 2015). The Chief Justice was, therefore, very persuasive in his opinion.
Effect on Uninsured Population
The ruling was favorable to millions of Americans across different states. In brief, the decision held that by providing health insurance subsidies to the individuals who purchased insurance through the Exchange established by the state, the Congress also meant to offer subsidies to the individuals who had purchased insurance coverage via the Federal Exchange (Lempert, 2015). The ruling, therefore, protected the citizens living in states that had not established exchanges. Had the court ruled otherwise, it is estimated that more than 6 million Americans living across 34 states would have lost subsidies (Lempert, 2015). Loss of subsidies would have released millions of people from the requirements of ACA since according to the Act, insurance costs should not exceed 8% of one's income. Resultantly, millions of Americans would forego insurance. The shrinking insured base would push health insurers to raise their rates, which would in turn free more people from the requirements of ACA. This cycle would trap Obamacare in a death spiral (Lempert, 2015). The decision, therefore, helped prevent this catastrophe. The subsidies helped millions of citizens purchase insurance, which in turn would help enhance universal health coverage. In states such as Florida where a state exchange system had not been established, more than one million citizens would have lost their tax credits.
Effect on Medicaid
The decision of the court was seen as a new lifeline for Medicaid, which was being opposed and criticized by various parties around the country. Even before the decision was made, supporters of Medicaid had produced numerous studies warning of the consequences that would occur if the court was to declare that the extension of health insurance subsidies to citizens in states using federal exchanges as illegal (Turner, 2015). This shows the huge positive impact that the decision had on Medicaid. Though various parties kept on the fight against the Act and the present administration has made attempts to overthrow, the decision by the Supreme Court gave it a chance of survival. By ruling that health insurance subsidies should be extended even to citizens in states that were operating under the federal exchange, the decision increased the chances of more Americans purchasing insurance. This would, in turn, enhance access to universal healthcare across the country. These were the main targets of Medicaid. Therefore, the decision helped push the agenda of Medicaid.
King v. Burwell, is among the most monumental decisions made the Supreme Court. This might be due to the magnitude of the issue in contention; Medicaid. By ruling that health insurance should be extended to all eligible citizens, the court helped keep the Act alive. Though the Chief Justice together with the other justices of the Supreme Court have been accused of bowing to political influence, this paper has made it clear that the justices were not concerned with determining whether the intentions of the Congress were noble or not. Rather, the Supreme addressed an ambiguity in the law, and the Chief Justice was satisfactorily persuasive in his opinion.
CONSTITUTIONAL ACCOUNTABILITY CENTER. (2019). King V. Burwell. Retrieved May 19, 2019, from Constitutional Accountability Center: https://www.theusconstitution.org/litigation/king-v-burwell-u-s-sup-ct/
Lempert, R. (2015, June 26). King v. Burwell: Roberts Court is clear on Obamacare ambiguity. Retrieved from BROOKINGS: https://www.brookings.edu/blog/fixgov/2015/06/26/king-v-burwell-roberts-court-is-clear-on-obamacare-ambiguity/
Rosenbaum, S. (2015). King v. Burwell and Beyond: Implications for Public Health Policy and Practice. Public Health Reports, 130(6), 731-734. doi:https://dx.doi.org/10.1177%2F003335491513000622
Slattery, E. (2015, July 25). In King v. Burwell Decision, Supreme Court Justices Acted as Lawmakers, Not Judges. Retrieved from The Heritage Foundation: https://www.heritage.org/courts/commentary/king-v-burwell-decision-supreme-court-justices-acted-lawmakers-not-judges
Turner, G.-M. (2015, May 18). Impact Of A King v Burwell Win: 'The Rest Of The Story'. Retrieved from Forbes: https://www.forbes.com/sites/gracemarieturner/2015/05/18/impact-of-a-king-v-burwell-win-the-rest-of-the-story/#22c557d87288
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