Today’s Supreme Court decision in King v. Burwell leaves no doubt that health reform is here to stay. Of particular importance, Chief Justice Roberts’ opinion for the majority recognizes the Affordable Care Act’s intent to expand the availability and affordability of coverage in the individual health insurance market and premium tax credits’ importance to make that happen. The Court refused to play a game of “gotcha” based on the King plaintiffs’ cramped reading of the law that would have isolated four words from its overall structure and meaning.
The Court said the “economic and political significance” of whether premium tax credits are available in states using the federal marketplace takes the question beyond what Congress could defer to an agency like the IRS to determine; the Court had to determine what Congress intended. It found it “implausible” that Congress could have intended that the individual insurance markets in states without their own exchanges enter into the death spiral that would occur without the tax credits, whereby fewer people would buy insurance, shrinking the coverage pool and driving up premiums to unaffordable levels for enrollees left behind. The Court’s finding is beyond dispute on the meaning of the law, and because it made the finding itself, without deferring to the IRS or another agency, a future administration can’t interpret otherwise.
The law is working. Since it took effect, 16.4 million uninsured people have gained health insurance coverage. As President Obama said this morning, it’s time to make it work even better and to get more people enrolled. And it’s time for the 21 states that haven’t yet expanded Medicaid to close the coverage gap so all Americans have a pathway to coverage.