1) This wasn't a "win for Obamacare." Obamacare is words written on paper. This was a win for the more than 6 million people who will keep their health insurance. It's a win for parents who can be sure their children can go to the doctor, and for minimum-wage workers who can call an ambulance without worrying about debt. Basic health security for millions of people was on the line in this decision. Everything else was secondary to that.
2) This was also a win for common sense, and for judicial restraint. On some level, what's most surprising about this case isn't that the Supreme Court upheld the subsidies, but that they ever took the case at all. This was a ridiculous case, based on a ridiculous argument, where the only hope of victory was that the Supreme Court had become an irreversibly partisan institution.
3) In the majority opinion, Chief Justice John Roberts put the fundamental absurdity of King v. Burwell's argument clearly: "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them." Indeed.
4) Something to note: The Supreme Court didn't take an easy out — they didn't use something like Chevron deference to split the difference or say it's simply not their role to second-guess the IRS. They didn't write an opinion that gave any shelter to the plaintiffs' argument. Instead, Roberts says that the Court's role in a case like this is to "determine the correct reading of the law." And that's what they did.
5) The correct reading of the law, Roberts writes, is the government's reading. The plaintiffs in King v. Burwell claimed that the law came down to five words: "an Exchange established by the State." Read on their own, those words suggested that only state-based exchanges could use subsidies. But the government argued that those words weren't on their own. The law also said, in the absence of a state-based exchange, the law tells the government to establish "such Exchange."
6) In the Court's opinion, the word "such" made all the difference. It makes clear that "the Act indicates that State and Federal Exchanges should be the same." If state exchanges got subsidies and federal exchanges didn't, then they wouldn't be the same.
7) But the Court goes further than that. They do not rest their decision on semantics. They rest it on clear legislative intent.
8) The decision begins with a lengthy description of Obamacare's "three-legged stool" — the way the law's subsidies, individual mandate, and regulations work together to create stable insurance markets. It then segues into the history of insurance death spirals in states that have tried to reform their health systems without building all three legs of the stool.
9) Roberts gives a very crisp definition of how these death spirals worked: "As premiums rose higher and higher, and the number of people buying insurance sank lower and lower, insurers began to leave the market entirely. As a result, the number of people without insurance increased dramatically."
10) In the Court's opinion, the plaintiffs' idea of how the law was meant to work is ridiculous. If they were right, then "the combination of no tax credits and an ineffective coverage requirement could well push a State's individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner."
11) In the end, the basic finding here isn't very complicated: Obamacare was designed to work the way everyone understood Obamacare was designed to work — which is also the way Obamacare has been working, and is also the only way Obamacare actually will work.
12) The plaintiffs argued that Obamacare was designed to work in a way contrary to its fundamental goals — that it was, in essence, built to fail, at least in states that didn't establish their own exchanges. The plaintiffs argued this even though no member of Congress ever mentioned this insane plan, no state was ever told about it, and the Obama administration expressly denied it. The majority rightfully saw this as what it is: less a serious argument about the law than an effort to wound Obamacare by successfully pulling a Jedi mind trick on the Supreme Court.
13) As the Court says, quoting New York State Dept. of Social Servs. v. Dublino, "We cannot interpret federal statutes to negate their own stated purposes."
14) The majority's opinion ends on a philosophical note — not about health care, but about the role of the judiciary, and the role that the plaintiffs were trying to push the judiciary into playing. It's worth quoting at length:
In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined—"to say what the law is." That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan.
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 plaintiffs, and many Republicans, were asking the Court to engage in judicial activism of breathtaking scale — using an unclearly worded sentence to upend the clear intent of one of the most significant laws passed in the last generation. In the end, the Court's four Democratic appointees, and two of its Republicans, refused. We should all be glad they did.
