ACA

  • December 18, 2014

    by Jeremy Leaming

    In a surprising, unsettling move late in the year, the U.S. Supreme Court decided to hear a challenge to an Obamacare provision integral to keeping the popular health care law functional.

    In case you missed them, we suggest some more interesting, persuasive and measured responses to the statutory challenge below. We provided other noteworthy and powerful articles, earlier in the fall, which are available in this post.

    The material we’re highlighting now is from legal scholars, who in different ways have examined the legal argument against crucial language in the Affordable Care Act meant to help low-income Americans afford health care coverage. (Also see the Dec. 18 piece for ACSblog by Georgia State University law school Professor Neil Kinkopf.)

    Andrew Koppelman, the John Paul Stevens Professor of Law and Professor of Political Science at Northwestern University, in a piece for the New Republic looks at the efforts to topple the ACA. A legal argument aside, Koppelman writes, “When is it acceptable to deliberately aim to harm huge numbers of people in order to score a symbolic point?” If the argument were to win at the Supreme Court, which is likely to hear oral argument early in 2015, “about 4.5 million low-and-middle workers” in numerous states would lose health care coverage, he notes.

    At The Incidental Economist, University of Michigan law school professor Nicholas Bagley, who posted for ACSblog earlier this year on the argument when it was before the D.C. Circuit, provides a grouping of his articles, posts and podcast discussions about the matter now before the Supreme Court.  “My first post,” he wrote was devoted to showing why “the government’s contextual reading of the ACA makes better sense of the statute than the challengers’ cramped reading of a single provision. A district court judge in D.C. endorsed that reasoning the day after I wrote the post; I wrote about his decision here.”

    A compelling and accessible look at the statutory challenge to the ACA comes from Professor David Ziff, a Law Lecturer at the University of Washington School of Law. Ziff focuses on the legal argument being made against the ACA, and the need to seriously engage it.

  • December 18, 2014

    by Neil Kinkopf, Professor of Law, Georgia State University.

    The House of Representatives has passed over 50 measures to repeal the Affordable Care Act. The Supreme Court hasn’t yet entertained quite that many challenges, but it seems intent on catching up. Having resolved the major constitutional controversies, the latest challenge, King v. Burwell, is statutory. 

    To understand the arguments and the stakes in this case, we have to first take a step back and review how the ACA works. The ACA requires (almost) all individuals to have qualified health insurance. This requirement of nearly universal coverage is crucial to making the Act work. To make health insurance affordable, the Act provides subsidies to income-eligible individuals. To make health insurance available, the ACA seeks to establish a marketplace – an exchange, in the terms of the Act – in each state. The Act contemplates that each state government will establish an exchange. If a state government fails to establish an exchange, the federal government is mandated to step in and establish an exchange for the state.  

    The ACA grants subsidies to income-eligible individuals who purchase insurance on “an exchange established by the state.” This is the key phrase, for the challengers assert that it refers exclusively to exchanges established by state governments. If that interpretation is correct, the consequence is that individuals in states whose exchange is established by the federal government (because their state government refused or failed to establish one) are ineligible for the insurance subsidy. This, according to the law’s proponents, would gut the ACA, rendering health insurance unaffordable for millions of Americans. The law’s challengers reply that the meaning of the phrase is plain and that meaning must prevail.  There are many excellent posts demonstrating that the challengers’ plain meaning reading is inconsistent with the text and structure, not to mention the purpose and intent, of the ACA. I do not wish to repeat those arguments. Instead, I want to examine whether the challengers’ reading of the statute actually captures the plain meaning of the key phrase without resorting to the ACA’s broader structure and context (which, I hasten to add, are essential components of proper textualist, plain meaning analysis).

  • August 8, 2014
    Guest Post

    by Nicholas Bagley. Bagley is an Assistant Professor at University of Michigan Law School. 

    *This post originally appeared on The Incidental Economist. 

    Now that the government has asked the full D.C. Circuit to rehear Halbigsome commentators have suggested that it’s an inappropriate candidate for en banc review. A Wall Street Journal op-ed from a lawyer representing a right-wing health-care think tank, for example, says that en banc review ought to be reserved for “cases raising serious constitutional issues.” Halbig, though, is just a “straightforward statutory interpretation case.”

    This is wrong for so, so many reasons. Under the Federal Rules of Appellate Procedure, a case can be taken en banc if it involves “a question of exceptional importance.” The rule does not say “a constitutional question of exceptional importance.” No judge, to my knowledge, has ever suggested that the rule be read so narrowly.

    To the contrary, the rules are drafted in open-ended terms—“exceptional importance”—because cases differ in their importance along many different dimensions. Some cases are trivial in themselves but present novel legal questions that will affect hundreds of other cases. Others are of “exceptional importance” because they implicate questions of faith or principle.

  • August 7, 2014
    Guest Post

    by Robert N. Weiner, Litigation Partner, Arnold & Porter LLP

    *This post originally appeared on Balkinization

    On July 22, in Halbig v. Burwell, a panel of the D.C. Circuit ruled 2-1 that low income families cannot get the tax subsidies the Affordable Care Act granted to enable them to afford health insurance, if their states opted to have the federal rather than the state government set up health insurance exchanges. Within hours, in King v. Burwell, a unanimous panel of the Fourth Circuit held just the opposite, that subsidies are available on all exchanges established under the Act. (I filed amicus briefs on behalf of Families USA in both cases.) 

    In making its ruling, the D.C. Circuit panel simultaneously issued an order on its own initiative making clear that its judgment was not effective until the full Court of Appeals decided whether to reconsider the case. The panel perhaps recognized that the other judges on the Court might view the decision as out of step with the Circuit’s precedents. A decision by the en banc Court to reconsider will automatically vacate the panel opinion. If the majority of the Court then concludes that the panel decision was wrong, they will issue an opinion reflecting the correct result.

    In arguing against en banc review in a Volokh Conspiracy post on August 5, Professor Jonathan Adler quotes with evident approval a 17-year old disquisition by Judge Harry Edwards, the dissenter in Halbig, regarding the standards for en banc review. The temptation of scoring a “gotcha” against Judge Edwards appears to have displaced reasoned analysis to whether those views make sense in this case. For example, Professor Adler commends Judge Edwards’ 1987 view regarding the limited value of having the entire D.C. Circuit reconsider en banc the 2-1 vote of the three-judge panel. A vote of 6 out of 11 judges, it is claimed, has no greater “legal validity” than a vote of 2 out of 3. If the implication is that any panel decision is as likely as an en banc ruling to be correct, then it was overbroad in 1987, and it is particularly fallacious here. Human fallibility being what it is, judges sometimes get an answer wildly wrong. As a matter of probability and logic, 6 judges are less likely to go off the deep end than 2. 

  • July 24, 2014
    Guest Post

    by Abbe Gluck, Professor of Law, Yale Law School

    *This piece originally appeared at Balkinzation

    I had hoped to take a day off blogging about Halbig and King (the ObamaCare Subsidies cases), but I cannot allow another inaccurate narrative about ObamaCare to take hold. Over at Volokh, my friend Ilya Somin argues that the holding in Halbig is not absurd because Congress uses statutory schemes all the time that try to incentivize states to administer federal law (and to penalize them if they don't). It is true we see schemes like that all the time -- Medicaid is a prime example -- but the insurance exchange design is NOT one of them. This federalism argument was made before the D.C. Circuit and even Judge Griffith didn't buy it in his ruling for the challengers. I tried to dispel this myth back in March, when I wrote the following on Balkinization:

    “This is not a conditional spending program analogous to Medicaid.”
        
    The challengers' strategy in this round has been to contend that the subsidies are part of an overarching ACA "carrots and sticks" strategy to lure states into health reform and penalize them if they decline. On that version of the story, it might make sense that subsidies would be unavailable in states that do not run their own exchanges. In their view, the subsidies are therefore exactly like the ACA’s Medicaid provision (from appellants’ brief: “The ACA’s subsidy provision offered an analogous ‘deal’ to entice states to establish Exchanges – because Congress (wisely, in hindsight) knew it had to offer huge incentives for the states to assume responsibility for that logistically nightmarish and politically toxic task.”) 

    Putting aside the fact that no one thought the states wouldn’t want to run the exchanges themselves (indeed, Senators were demanding that option for their states), the exchange provisions simply do not work in the same way as Medicaid. Unlike the ACA’s Medicaid provisions, the exchange provisions have a federal fallback: Medicaid is use-it-or-lose-it; the exchanges are do-it, or the feds step in and do it for you. In other words, this isn’t Medicaid; it’s the Clean Air Act (CAA). If a state decides not to create its own implementation plan under the CAA, its citizens do not lose the benefit of the federal program -- the feds run it. The same goes for the ACA’s exchanges and so it would be nonsensical to deprive citizens in federal-exchange states of the subsidies. More importantly, if we are going to compare apples to oranges, the ACA’s Medicaid provisions have an explicit provision stating that if the state declines to participate, it loses the program funds (this was the provision at issue in NFIB v. Sebelius in 2012). The ACA’s subsidy provisions, in contrast, have no such provision, strong evidence that the subsidies were was not intended to be forfeited if the states did not participate. If the challengers are going to insist on strict textual arguments, this is exclusio unius 101: the rule of interpretation that provides that where Congress includes a specific provision in one part of the statute but does not include an analogous provision elsewhere, that omission is assumed intentional."
     
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    It may be true that the ACA’s politics have created a landscape no one ever predicted – one in which federalism-focused states, whose congressional representatives were demanding the states’ rights to establish exchanges instead of the federal government – have decided that politics is more important than federalism and opted out. But what’s happened in hindsight doesn’t change what happened when the statute was enacted and how the statute is actually designed. What happened when the statute was designed was that no one thought the states needed a carrot to do this and the statute was never designed as a "use or lose it" incentive, like Medicaid.