King v. Burwell Is History, But Its Legacy Lives On

» Posted by on Dec 24, 2015 in David DelCollo | Comments Off on King v. Burwell Is History, But Its Legacy Lives On

King v. Burwell Is History, But Its Legacy Lives On

Unless you’ve been oblivious of the political conversation since the beginning of Barack Obama’s presidency, you’re likely aware of a law known as the Patient Protection and Affordable Care Act (PPACA). PPACA is also known as the Affordable Care Act (ACA), but most folks know it simply as Obamacare.

Whatever you call it, the ACA dramatically reordered the American healthcare landscape, which was already changing rapidly. Legal experts like Philadelphia attorney David DelCollo can argue interminably about the legal merits and inconsistencies of the ACA, but most people on the street simply want to know how it affects them in practical terms.

Needless to say, some folks are up in arms about the ACA’s perceived drawbacks and possible long-term deleterious effects: higher insurance premiums, thinner coverages, lower-quality care. It’s too early to say whether these issues are salient, and the fact that career healthcare experts draw on the same sets of facts to offer diametrically opposed opinions on the subject gives rational people ample cause to reserve judgment.

Of course, cause for caution hasn’t stopped many who vehemently oppose the ACA. During the law’s short lifespan, several lawsuits have attacked its legality. Most, like King v. Burwell, have focused on one (or a handful) of aspects that, when viewed from the plaintiff’s perspective, run contrary to the rule of law.

David DelCollo has worked on healthcare law and policy for a number of years. Here’s his “30,000 foot guide” to King v. Burwell.

How Did King v. Burwell Wind Up?

King v. Burwell focused on a curious turn of phrase in a core ACA passage: “through an Exchange established by the State.” “Exchange” refers to a health insurance exchange; the meaning of “State” is (or was) less clear. Does “State” refer to individual states that are, according to other sections of the law, responsible for setting up their own health insurance exchanges? Or is it a pedagogical reference to the federal government, which is certainly a “State” under any commonly accepted political framework?

“This was a big deal,” says DelCollo, “because the broader context of that passage concerned the legality of health insurance subsidies granted by the federal government.” Without those subsidies, he adds, citizens in states without health insurance exchanges would likely be unable to afford health insurance purchased on the federal exchange.

There wasn’t any serious debate among the justices as to the meaning of the passage. All agreed, per SCOTUSblog, that “State” referred to individual states as written.

So… case closed? Nope. By a 6-3 majority, the Court ruled that the intent of the passage hewed more closely to the latter definition of “State,” and thus that policies offered through all exchanges were eligible for subsidies. Their reasoning was that a more literal interpretation of the statute would lead to significant “adverse consequences,” i.e. millions of people suddenly finding themselves unable to afford the health insurance policies they’d purchased in good faith.

Many observers argued that the Court’s decision was harmful for the rule of law — that, in interpreting a statute in a manner other than written, the Court left the door open for more egregious violations (or instances of willful ignorance) of the law.

King v. Burwell probably isn’t the first Supreme Court case to decide the meaning of a hastily written law, but it’s certainly the most high-profile and politically charged instance we’ve seen in a long time,” says DelCollo.

It’s not yet clear whether the outcome of the case will materially affect the Court’s approach to future cases that turn on awkward phrasing. “Adverse consequences” may well turn out to be a situation-specific blip on the Court’s radar, rather than a lasting precedent that upends decades of well-worn Supreme Court handicapping.

Not the Final Act?

King v. Burwell likely won’t be the last attempt to dismantle part or all of the Affordable Care Act. The law remains a political hot button, and activity by proponents and opponents alike is likely to intensify, not relax, as time goes on.

“I think it’s fair to say that the fight over the Affordable Care Act is still in the middle innings,” says DelCollo, “despite the fact that the law has been on the books for several years. The dispute is all but certain to outlive [Barack] Obama’s presidency.”

Whether attempts to bolster or harm the law occur through legislation, civil litigation or both, healthcare policy junkies will have plenty to chew on in the months and years to come. Here’s to hoping that, whatever the final outcome, Americans are still able to obtain the healthcare they need at a price they can afford.