In a widely anticipated decision, the US Supreme
Court on Thursday June 25 upheld President Obama’s signature healthcare law,
the Patient Protection and Affordable Care Act, against the latest
challenge. In a 6-3 ruling the
Court held that the subsidies which make healthcare costs affordable for
millions of low-income Americans were available to everyone throughout the US,
not just to those in states which established their own healthcare exchanges.
Opponents had argued that the wording of the law
suggested Congress had only intended for subsidies to be available where states
themselves set up exchanges for their citizens to purchase healthcare
insurance. Because only fourteen
states established such exchanges, however, the impact of a decision favouring
their position had been widely expected to mean the loss of insurance for between
six and eight million low income Americans and the possible unsustainability of
Obamacare in the longer term. The
latter consequence, the failure of programme entirely, had been advocated by a
number of conservative and libertarian opponents of the law. Republican opponents in Congress have
repeatedly tried to repeal the healthcare law, thus far without success. The Court’s decision on Thursday cut
off another angle of attack.
The successful working of the Affordable Care Act
rests on three interlinked provisions.
Insurers cannot refuse coverage to individuals with pre-existing health
conditions. To ensure that people
do not wait until they are ill to purchase insurance, the Act requires
individuals to purchase insurance in some form. Finally, to make insurance affordable, the Act provides
subsidies to families with low incomes (defined as between one hundred and four
hundred percent of the federal poverty line) which in practice can reduce the
cost of insurance to the individual by up to 80%. Three years ago the Court narrowly upheld a challenge to the
so-called “individual mandate” which requires Americans to purchase
insurance. This was important in keeping
premiums low: including people with no current health problems ensured the risk
to insurers was kept low and thus premiums remained affordable.
The challenge in King v. Burwell focused on exchanges created by the Affordable Care
Act’s provisions, in essence markets where individuals could compare and
purchase insurance plans. The
challengers argued the wording the law meant only insurance purchased via
exchanges created by the states was eligible for subsidies. Although recognising that their
arguments were “strong” in regards to the exact wording of the challenged
provision, the Court nevertheless held that “such a reading turns out to be
untenable in light of the statute as a whole.” Seemingly recognising the very real consequences for
millions of Americans of a different ruling, the Court concluded, “Congress
passed the Affordable Care Act to improve health insurance markets, not to
destroy them. If at all possible
we must interpret the Act in a way that is consistent with the former, and
avoids the latter.”
The majority opinion was written by Chief Justice
John Roberts. Three years ago he
sided with the Court’s liberals to provide the deciding vote to uphold the
individual mandate. As a result he
was praised by many liberals for his “statesmanship” and lambasted by
conservatives for betraying their cause.
Since the Court announced in November last year that it would take the
case much of the commentary has focused on whether Roberts would take the same
path this time. Clearly he did,
but he and the Court’s liberals (Justices Breyer, Kagan, and Sotomayor) were
joined by Justice Anthony Kennedy who, in 2012, voted to strike down the
individual mandate. In the last
few months commentators had speculated that Kennedy might be convinced to join
the majority but it was just that, speculation. Many will be surprised, and either pleased or dismayed
depending on their view of Obamacare, by his siding with the majority this time
round. Roberts, however, might be
particularly relieved that a second challenge to Obamacare was not decided by a
narrow majority which rested entirely on his vote.
King v.
Burwell ultimately leaves Obamacare untouched, but the Court’s ruling
carries huge significance. Twice
now the Court has upheld the law against legal challenges driven by its
political opponents. While this
decision is unlikely to stop the challenges entirely, it does place the law in
a much stronger position. The
longer the law continues to operate, the more likely people are to simply
accept its presence. And as more
people benefit from the law, the less likely opponents are to find traction
among voters for seeking its repeal.
As such, unintentionally, the Court may have terminally weakened the
political case against Obamacare.
The longer legacy of the decision, however, is that millions of
Americans will continue to have affordable healthcare.
Emma Long is a Lecturer in American History at UEA. Her research interests include the history of the US Constitution and the Supreme Court, as well as the interaction of religion and politics in American history.
