Affordable Care Act

  • August 3, 2015
    Guest Post

    by Simon Lazarus, Senior Counsel, Constitutional Accountability Center

    *This post originally appeared on Balkinization.

    Chief Justice John Roberts sent President Obama off for the July 4 holiday in what must have been a good mood, secure that his signature legislative accomplishment, the Affordable Care Act, had survived a second lawsuit designed to cripple it.  In King v. BurwellRoberts had mobilized a 6-3 majority to reject a claim by health reform opponents that ACA-prescribed tax credits were not available on federally run exchanges.  In addition to helping secure Obama’s legacy, the decision evidently bumped up Obama’s public approval ratings.  But the celebration must be tempered.  This big win is not the President’s doing, nor that of the Executive Branch he controls.  Instead, it was due to two conservative justices, the Chief and Associate Justice Anthony Kennedy, whose agendas, while generally divergent from his, meshed on this important occasion.  How often will these stars align again? 

    That question is not academic.  King v. Burwell is by no means the last case in which the President’s political opponents are seeking to cancel or gut his key initiatives.  Indeed, two currently await decisions in lower federal courts. The first lawsuit is Texas’ challenge to the Administration’s immigration policy—to defer, on a case-by-case basis, removal of some four million undocumented immigrants who do not fall within DHS priorities for enforcing the nation’s immigration laws. The second lawsuit is House Republicans’ challenge to significant components of the administration’s ACA implementation.  A third challenge, to the EPA’s proposed Clean Power Plan —the crown jewel of Obama’s anti-global warming agenda— is likely when its regulations are finalized in early August.

    Over the next three days, I’ll discuss the upcoming challenges to Obama’s policy agenda. I begin, however, with a discussion of what Chief Justice Roberts’ opinion in King v. Burwell might mean for these lawsuits, and others that may follow them.

  • August 3, 2015
    Guest Post

    by Stacey Dembo, Law Offices of Stacey J. Dembo

    This summer will mark two important milestones for public benefit programs in the United States. The Social Security Act will be celebrating its 80th anniversary on August 14th‒President Franklin D. Roosevelt signed the Social Security Act into law on that date in 1935. And last week marked the 50th anniversary of the enactment of the amendments that expanded the Social Security Act to establish the Medicare and Medicaid programs. This 50th anniversary provides an opportunity for us to reflect on the vital lifelines Medicare and Medicaid provide for our nation’s most vulnerable.

    It’s hard to believe that before 1966 roughly half of all people 65 and over and many people with disabilities, children, pregnant women and low-income working Americans were unable to afford the medical care they needed. When President Lyndon B. Johnson signed the amendments creating Medicare and Medicaid, he said the programs would correct “the injustice which denies the miracle of healing to the old and to the poor.”

    Now 50 years later, Medicare and Medicaid together cover over 100 million people, or about 1 in 3 Americans. Medicare covers almost all elderly Americans and some younger adults who are disabled. Medicare Part A, which covers hospital stays, nursing home care and hospice, is financed by the payroll taxes workers and employers pay. Medicare Part B, which covers doctors’ visits, surgeries and medical devices like wheelchairs, is paid for by Medicare recipients through income-based premiums. Medicaid, on the other hand, is financed via federal and state funds. It covers low-income adults, people with disabilities, half of all low-income children and pregnant women.

  • June 30, 2015
    Guest Post

    by Robert N. Weiner, partner, Arnold & Porter LLP

    *This post originally appeared on casetext.com.

    The first lawsuit seeking to strike down the Affordable Care Act (ACA) came just seven minutes after the President signed the bill on March 23, 2010. The assaults continued even after the Supreme Court upheld the law as constitutional. For all but those first seven minutes, the ACA has weathered nonstop legal attack, as its opponents sought to enlist judges to undo their political defeats in Congress.

    To that end, an American Enterprise Institute Conference in late 2010 foraged through the 900 pages of the ACA in search of some plausible flaw to eviscerate the statute “as a matter of political hygiene.” All the quest turned up was an awkward phrase in what the Court in King called the “ultimate ancillary provision: a sub-sub-sub section of the Tax Code.” This previously undiscovered provision supposedly barred subsidies that help low-income families afford insurance if their States opted to have the Federal Government establish insurance Exchanges rather than doing it themselves. Congress, in other words, deliberately embedded a self-destruct mechanism deep in the statute.

    Before jumping to the four-word phrase at issue, it is not only useful but necessary to examine its context ‒ the history, purpose, and structure of the ACA, as the Court did in King. Congress enacted the ACA to reduce the number of people without health insurance. The law barred insurers from refusing to cover consumers because of their preexisting illnesses, but counterbalanced that prohibition with a requirement that virtually everyone maintain insurance coverage. To make that requirement affordable, the ACA directed each state to establish a marketplace, called an Exchange, that would function like Travelocity, affording individual consumers the knowledge and leverage to negotiate insurance contracts as favorable as those offered to purchasers of large group policies. To ensure that these Exchanges functioned everywhere, the Act instructed the Secretary of HHS to step in and establish “such Exchange” if the State did not do so itself. As a further step to make insurance affordable, the ACA also lowered the net cost by providing tax subsidies, based on income, for those purchasing policies on an Exchange.

  • June 25, 2015
    Guest Post

    by Eric J. Segall, Kathy and Lawrence Ashe Professor of Law, Georgia State University College of Law

    In a debate with Professor Jonathan Adler, one of the architects of the plaintiffs’ litigation strategy in King v. Burwell, in the Pennsylvania Law Review, I began as follows: “Many issues, both constitutional and statutory, that reach the United States Supreme Court raise difficult and complex interpretive and normative questions. . . . The King case, however, is different.”

    It was different, I argued, because Congress explained exactly what would happen if states refused to create their own health insurance exchanges (which 36 states refused to do). In that circumstance, under Section 1321 of the Act, the federal government was required to establish “such exchange,” as the ones established by the states. As the Court today said: “By using the phrase ‘such Exchange,’ [Section 1321] instructs the Secretary to establish and operate the same Exchange that the State was directed to establish.” That kind of exchange quite obviously was authorized by the law to offer federal subsidies, and that is exactly what today’s opinion held.

    If there were any doubts at all about the strength of the legal arguments made by the government and its supporters, Justice Roberts put them to rest by not relying on the Chevron rule of deference that says all reasonable agency interpretations of ambiguous statutory language should be upheld, but rather by siding with the government as a pure matter of law. Deference was not required, according to the Chief, because this was one of those “extraordinary cases” where Congress is unlikely to have intended that courts defer to agency decisions. This part of the opinion may well prove problematic in the future when courts evaluate agency decisions but today demonstrates that at least six justices of the United States Supreme Court were willing to say that Congress rather clearly and obviously expected federal subsidies to be available on federal as well as state exchanges.

    In addition to the pure legal analysis, the majority opinion also said that “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.”

    This language, while unnecessary to the holding in the case, may be a strong signal from the justices that it will not undo through legal means the Affordable Care Act. There are, after all, a number of challenges to the ACA still pending in the lower courts, including a baseless Origination Clause challenge to the entire law. Maybe, hopefully, the justices are indicating that the fate of the ACA rests in the political arena, not in partisan challenges dressed up as legal cases. At the end of the day, that may be the best news of all.

  • June 25, 2015
    Guest Post

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

    The Supreme Court’s decision in King v. Burwell is enormously consequential in many respects.  Initial commentary has focused, inevitably, on the decision’s consequences for the 2016 presidential candidates and for the millions of people who were in jeopardy of losing health insurance. Comparatively little attention has 

    been paid to how the Court decided the case, and for lawyers this is where to find the decision’s lasting significance.  In a subsequent post, I will examine what the opinion means for the ongoing debate over method in statutory interpretation. In this post, I want to discuss the administrative law aspect of the Court’s decision. 

    The Supreme Court’s ruling affirms the holding of the Fourth Circuit below, but specifically rejected its administrative law reasoning. The Fourth Circuit had held that the Affordable Care Act is ambiguous as to whether an HHS-created exchange should be included within the ambit of state exchanges for purposes of determining an individual’s eligibility for health insurance subsidies.  For that reason, the Fourth Circuit invoked the famous Chevron doctrine. Chevron, of course, instructs that where a statute is ambiguous, a court should defer to the agency’s interpretation of the statute as long as that interpretation is reasonable. 

    The Supreme Court disagreed. It held that, even though the ACA is ambiguous, Chevron is inapplicable because the Court is to defer the agency’s interpretation only if Congress meant to delegate authority to interpret the statute to the agency. Because the IRS has no particular expertise regarding the proper structure of a health care system, it is unlikely that Congress would have meant to delegate interpretive authority to the IRS. The Court then decided that the best interpretation of the ambiguous statute is that an HHS-created exchange should be treated as a state exchange. Because this happened to be the same interpretation the IRS had given the ACA, the Court affirmed the Fourth Circuit’s ruling in favor of the IRS interpretation. Again, the affirmance is based not on Chevron deference; the Court rather agreed that the government’s interpretation is the correct one.