On June 25th, 2015 the Supreme Court upheld ObamaCare’s subsidies 6-3 in a ruling on King V Burwell. Millions will keep their legal HealthCare.Gov subsidies and the IRS will continue to be able to issue subsidies to those who buy plans on the federal website.

In other words ObamaCare (the Affordable Care Act) remains the “law of the land”.

The truth is 7 in 10 polled didn’t know that King V. Burwell was happening or that subsidies were in danger of being repealed. Had the plaintiffs won millions could have lost health coverage and it could have sent us down a road to losing our new benefits, rights, and protections (including guaranteed issue for those with preexisting conditions).

As it stands this news may pass many people by, but make no mistake today is a historic day in the history of American healthcare.

Read the Supreme Court decision upholding Obamacare subsidies here.  Below we present our own summary of the King V Burwell decision in simple terms.

The Supreme Court Decision on King V Burwell Explained

Not everyone has the time to read the Supreme Court decision on King V Burwell, but understanding why SCOTUS ruled in favor of subsidies rather than the plaintiffs can help you understand the ACA, Supreme Court, Congress, the legal system, and the history of health care reform.

Below is a quick overview of everything you need to know to understand this in plain simple terms:

In the 1990’s a few states, including Massachusetts, decided to make it so insurers had to offer coverage to those with preexisting conditions (making coverage guaranteed issue). Things went bad fast, people loved the new rule… but instead of getting coverage they waited until they were sick to get covered. Insurers lost money and some even left the states creating an “economic death spiral”.

In 2006 Massachusetts (under Mitt Romney and with the help of Jonathan Gruber btw) fixed the above problem by adding a two crucial missing pieces to the puzzle, they added 1) tax credits (ie. health insurance subsidies) and 2) a fee for not obtaining coverage during a specific time of the year (along with exemptions for those who still couldn’t afford coverage). The mandate doesn’t work without tax credits, this is because without tax credits people with incomes below 400% of the Federal Poverty Level statistically end up paying more than the key 8% of their incomes for coverage. If everyone is exempt from the law and people can buy coverage whenever, then the whole thing falls apart and it creates an “economic death spiral”.

Fast forward to 2010, President Obama passes a very similar healthcare reform law in the style of the successful Massachusetts reform. The new law, the Affordable Care Act, also has 3 key pieces: 1) health insurance options for everyone 2) subsidies 3) and a mandate. The wording of the 1,000 pages isn’t perfect and some sections are a little questionably written… but when read in whole and in context the meaning of each section becomes clear. It is meant to mirror the reforms that worked in Massachusetts and is meant to accomplish the 3 things listed above.

Fast forward to King V Burwell. 4 plaintiffs (organized by Conservative Libertarian think tanks in an effort to bring down the ACA) said they should be exempt from the mandate. They said that a part of the law says only “exchanges established by the state” (one of those not so well written sections) should get subsidies and thus they shouldn’t get subsidies, thus they should be exempt from the requirement to get coverage as coverage would cost more than 8% of their income. (The plaintiffs live in Virginia and Virginia didn’t set up their own exchange).

Fast forward to the King V Burwell ruling. The Supreme Court decides 6 – 3 that despite the section of the law being poorly written, that when read in context the law must be read to mean that the 3 key pieces stand. In the passage “the state” must be referring to states or the federal government, as that is the only way the law would make sense in context. Why would congress pass a law meant to mirror the Massachusetts law and then in only one section sneak a part in there undoing 2 of the 3 key pieces for all states that failed to create their own exchange? Congress must have meant “the state” to refer to both states and the federal government.

The lawsuit didn’t rest upon one of the key parts, whether it was up to the IRS to interpret the meaning of the law as experts (“the Chevron defense”). This is because the decision said the law itself was clear enough on its own. The Affordable Care Act is written to mean that all states can issue subsidies whether they have set up their own exchange or whether the federal Government sets up that exchange for them.

Summary: SCOTUS says congress would not have passed a law that treated some states differently than others. Giving some states the failed 1990’s version of healthcare reform and giving other states the fixed Massachusetts / ACA version based on whether they created an exchange themselves or deferred creation to the federal government would make no sense. When the whole law is read in context the intentions of the ACA are clear. For the ACA to work we must have:

1. Open Enrollment / a Mandate

2. Guaranteed coverage

3. Premium Tax Credits

This decision hints that further healthcare reform proposals, including a future repeal attempt by the GOP must include or address all three of these points.

What do you think?

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N. Clark on

Decision based on “context”?! You could pose a theoretical question to 100 folks and come up with 100 different “contextual interpretations” of said question. Unbelievable that SCOTUS doesn’t buy the idea that Congress did not intend to force states into creating these Exchanges. Congress absolutely meant to pass on this monstrous burden to individual states and therefore individual citizens. Remember folks, Congress doesn’t even want the ACA to apply to them personally…that alone should speak volumes.

Michael Lockwood on

Agreed with N. Clark.

This would hardly be the first time that the federal government used federal funding to strong arm states in to obedience. In this case, however, it completely blew up in their faces. The section of the law meant exactly what it said. States wouldn’t get the funding and their constituency would pressure the states to accept federal mandates.

Luckily for Obama, the SCOTUS has his back.

Charles Logan on

My wife being on disability and very sick.I pay a large sum of money just trying to keep her alive. I can’t afford the coverage for myself even with the subsidy. Because they are counting her disability partially as income for me. I do not get any of this money because it goes to her care. So thanks for nothing

ObamaCareFacts.com on

Very sorry to hear this, disability of course is help from the same Government and taxpayers who provide assistance through the ACA. So it’s not “nothing”. That being said, it is certainly frustrating to have disability income counted toward MAGI in some cases as it lowers cost assistance levels or in some cases removes them completely. In other cases it is the only way a person can afford health insurance. You see, if a state doesn’t expand Medicaid, a person may rely on disability income to boost their income above 100% of the Federal Poverty Level (if they are not yet eligible for Medicare). From what I understand the system is meant to be fair and to help the most people. The best advice is to really look at your MAGI income and shop around Silver plans on the Marketplace to see what will be the best value over time with out-of-pocket and premium costs and subsidies included. Hope things look up soon.

Donald J.Ludwig LFACHE on

In 1974 I tried to set-up such a plan in Contra Costa County,Californis.It was way before it’s time and was not approved by the Federal Governemnt.so I am delighted to see “Obamacare”.It will save billions of dollars and improve the health status of U.S. citizens.

Patricia on

I show the income level to qualify for Obamacare is min 11,000 plus.
I have a household of 2(myself and husband).
I am only trying to get health ins for myself. Husband has his own healthcare.
If I am only trying to get healthcare for myself but a household of 2-what is the income level requirement?

Thanks

ObamaCareFacts.com on

Income is based on household taxable income (that includes both family members, even though only one would be applying for cost assistance). The income to qualify for cost assistance for a family of 2 for 2016 coverage is %15,930 (100% FPL), the maximum is 63,720 (400% FPL).

This can be found by understanding your household income (for adult filers Modified Adjust Gross Income MAGI) and by looking at the 2015 Federal Poverty Level for a family of 2.

http://obamacarefacts.com/modified-adjusted-gross-income-magi/
http://obamacarefacts.com/federal-poverty-level/

Eloise on

I have a spelling correction. “enough on it’s own” This should be “its”.

ObamaCareFacts.com on

Good catch!

Mary Powers on

When did congress approve the issuance of these subsidies ? Was it before or after the republicans became majority.

ObamaCareFacts.com on

The subsidies are issued by the law that passed. As you can see from the cost sharing reduction court case, the GOP is fighting every subsidy related provision.