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.