The Affordable Care Act (or Obamacare, or As You Like It, or What You Will) has once again survived the Supreme Court. The Court has ruled in favor of the Obama administration in a case that many people (including many supporters of the ACA) felt might prove the undoing of the healthcare act.
At issue was whether people could receive subsidies to purchase insurance from a federal insurance exchange if they lived in states that had decided not to set up their own state-run health insurance exchanges. The ruling hinged on a single phrase in the ACA, which stated that people could only receive subsidies for buying insurance on “an exchange established by the state.” Opponents of Obamacare seized on this loophole in their ever-more desperate attempts to find some way--any way--to eliminate a law they found abhorrent, after losing consistently at the ballot box and, overwhelmingly, in the court of public opinion.
Common sense would suggest that the law's intent was always clear. Common sense would further dictate that, if the offending phrase really DID create confusion, the simplest remedy would be to revise the text of the law to eliminate ambiguity, e.g., "an exchange established by an individual state or the federal government, you nitpicking pedants." OK, maybe I'm embellishing. But of course common sense plays little role where politics are concerned, and a Republican-dominated Congress would certainly balk at putting forth even minimal effort to salvage a law that had provided health insurance to hundreds of thousands of previously uninsured and/or uninsurable citizens because. . . Well, because that's how they roll. Furthermore, if the phrase was, in fact, found to forbid subsidies to people receiving federal health insurance, that would effectively destroy the law, as people in states without exchanges of their own--millions of people--would suddenly find themselves once again unable to afford insurance. The fate of Obamacare, in other words, rested in the hands of a largely conservative Supreme Court.
Thankfully, the majority of SCOTUS acted conservatively--in the truest sense of the word--and opted not to eviscerate a law that has, overall, helped millions of people and, despite semantics, is functioning pretty much exactly as Congress intended. In the decision, Chief Justice John Roberts wrote that, “In this instance, the context and structure of the act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.” And while I celebrate the ruling, I cannot help but feel that the whole "controversy" over the phrase has been overblown. Indeed, a close reading of the phrase suggests that, in fact, subsidies for federal exchanges were always kosher.
For what does "the state" refer to in a piece of federal legislation? Sure, it can refer to any of the 50 states, but it can also clearly refer to the United States of America as a whole, in much the same way that the State Department--the "Department of STATE"--refers to an entity that represents the country as a whole. Now, if the relevant phrase had said, "an exchange set up by the stateS" or "an exchange set up by A state," the plaintiffs might have had a more plausible case. But, to this erstwhile English instructor at least, both the law's intent and phrasing were abundantly clear. Let's be thankful the Supreme Court saw it the same way.