IN ADVANCE of the Supreme Court taking its third crack at Obamacare, there was feverish speculation. The justices would vote according to their preferred policy outcomes, some said, striking down the subsidies that underpin the policy. Or the court’s conservatives would act to help Republican presidential candidates, preserving the subsidies to prevent a policy disaster for which the GOP would be blamed. Or maybe Chief Justice John G. Roberts Jr. would do whatever he thought was in the best interests of the institution of the Supreme Court.
No such untoward motivations were evident in the cogent ruling the court issued Thursday, which maintains government health-care subsidies for needy Americans in every state. Chief Justice Roberts and Justice Anthony M. Kennedy both joined the court’s liberal wing in endorsing the most reasonable reading of the statute, knowing they will face an angry backlash from the Obamacare-hating right. Perhaps the next time the court delivers a ruling that disappoints the left, the default position should not be to question its good faith.
The case decided Thursday, King v. Burwell, arose from a line in the Affordable Care Act that is, in fact, ambiguous. The law says that subsidies are available to those who buy coverage in a marketplace “established by the State.” Does that really mean, as the Obama administration’s opponents alleged, that the law denies subsidies to people in the majority of states that refused to establish a marketplace? The law, after all, also tells the federal government to establish “such” marketplaces in states that don’t do it on their own. That, among other things, suggests there should be no practical distinction between marketplaces established by states and that established by the federal government.
“Given that the text is ambiguous,” the chief justice wrote, “the Court must look to the broader structure of the Act.” Federal subsidies for insurance buyers are central to the policy, making the Affordable Care Act affordable. Without them, insurance markets would crumble. “It is implausible that Congress meant the Act to operate in this manner,” the opinion states. The court, therefore, wisely and modestly declined to rip apart the policy.
The practical impact of the ruling is unambiguously positive. Subsidies will not be suddenly revoked from people who rely on them to purchase health insurance. Insurance markets just beginning to find their footing in states across the country will continue to grow. A reasonable health-care policy has at least another year and a half to phase in under the supervision of a president who is committed to making it work, not undermining it. The law has not solved every problem in U.S. health care. But it already has done a lot of good, starting with the recent, dramatic drop in the uninsured rate.
It’s easy when disagreeing with a Supreme Court ruling, whether King v. Burwell or Citizens United, to dismiss it as the product of bad faith. Thursday’s ruling should encourage the court’s more strident critics to wonder who the real cynics are.
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