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O n J u n e 2 5 , 2 0 1 5 , t h e U . S . S u p r e m e C o u r t r u l e d i n K i n g v . B u r w e l l t h a t p r e m i u m s u b s i d i e s i s s u e d t o l i m i t e d - i n c o m e c o n s u m e r s e s t a b l i s h e d b y t h e A f f o r d a b l e C a r e A c t ( A C A ) c a n c o n t i n u e f l o w i n g t o c o n s u m e r s i n t h e 3 4 f e d e r a l l y r u n e x c h a n g e s . T h e 6 - 3 d e c i s i o n p r o t e c t s s u b s i d i e s a n d t a x c r e d i t s d i s t r i b u t e d t o n e a r l y 6 . 5 m i l l i o n c o n s u m e r s a n d p r e v e n t s w h a t w o u l d h a v e l i k e l y b e e n a m a s s i v e d i s r u p t i o n t o m a n y m a r k e t s .
I n t h e o p i n i o n a u t h o r e d b y C h i e f J u s t i c e R o b e r t s a n d j o i n e d b y J u s t i c e s K e n n e d y , G i n s b u r g , B r e y e r , S o t o m a y o r a n d K a g a n , t h e C o u r t r u l e d t h a t w h i l e t h e p l a i n t i f f s c o n t e n t i o n t h a t t h e c l a u s e a n e x c h a n g e e s t a b l i s h e d b y t h e s t a t e s l i m i t e d s u b s i d i e s t o o n l y s t a t e - r u n e x c h a n g e s w a s s t r o n g , t h e i r o v e r a l l a n a l y s i s o f t h e l a w s s t r u c t u r e d i d n o t s u g g e s t t h a t s u b s i d i e s s h o u l d o n l y a p p l y t o r e s i d e n t s b u y i n g c o v e r a g e o n s t a t e - r u n e x c h a n g e s d e s p i t e t h e i n a r t f u l d r a f t i n g . I n a s h a r p l y w o r d e d d i s s e n t a u t h o r e d b y J u s t i c e S c a l i a a n d j o i n e d b y J u s t i c e s T h o m a s a n d A l i t o , S c a l i a a r g u e d t h a t t h e m a j o r i t y o p i n i o n o f t h e C o u r t o v e r s t e p p e d i t s b o u n d a r i e s a n d s h o u l d h a v e l e t C o n g r e s s d e c i d e h o w t o a d d r e s s t h e a v a i l a b i l i t y o f t a x c r e d i t s . I n a l l u d i n g t o t h e C o u r t s 2 0 1 2 r u l i n g t h a t u p h e l d t h e i n d i v i d u a l m a n d a t e b y f i n d i n g i t a t a x a n d i n v a l i d a t i n g t h e m a n d a t o r y M e d i c a i d e x p a n s i o n , S c a l i a w r o t e W e s h o u l d s t a r t c a l l i n g t h i s l a w S C O T U S c a r e .
A s a r e s u l t o f t h e C o u r t s d e c i s i o n , t h e f e d e r a l l y - r u n e x c h a n g e s w i l l c o n t i n u e t o o p e r a t e a s t h e y d o t o d a y , o f f e r i n g s u b s i d i e s a n d t a x c r e d i t s t o m i l l i o n s o f c o n s u m e r s . T h i s d e c i s i o n a l s o m e a n s t h a t t h e r i s k p o o l f o r t h e i n d i v i d u a l i n s u r a n c e m a r k e t w i l l n o t b e d e s t a b i l i z e d a s w o u l d h a v e l i k e l y h a p p e n e d i f m i l l i o n s o f c o n s u m e r s w e r e u n a b l e t o a f f o r d c o v e r a g e . H a d t h e C o u r t r u l e d a g a i n s t t h e u s e o f s u b s i d i e s i n f e d e r a l l y - r u n e x c h a n g e s , h e a l t h i e r s u b s i d i z e d c o n s u m e r s w o u l d h a v e l i k e l y l e f t t h e f e d e r a l l y - r u n e x c h a n g e s f a r m o r e t h a n l e s s h e a l t h y c o n s u m e r s r e s u l t i n g i n s i g n i f i c a n t r a t e i n c r e a s e s o n t h o s e c o n s u m e r s c o n t i n u i n g t o b e i n s u r e d . T h e d e c i s i o n a l s o p r o t e c t s h e a l t h c a r e s t a k e h o l d e r s i n s u r e r s , p r o v i d e r s , d e v i c e a n d d r u g m a k e r s t h a t m a d e s p e c i f i c i n v e s t m e n t s b a s e d o n t h e p o s i t i v e i m p a c t o f t h e s u b s i d i e s o n t h e i n s u r a n c e m a r k e t .
B u t K i n g v . B u r w e l l d o e s n o t e n d t h e d e b a t e . L e g a l c h a l l e n g e s c o n t i n u e , a n d t h e r e a r e n u m e r o u s b i l l s i n C o n g r e s s t h a t w o u l d r e p e a l o r r e s t r u c t u r e s i g n i f i c a n t p a r t s o f t h e A C A . P o l i t i c a l l y , t h i s d e c i s i o n e n a b l e s R e p u b l i c a n s w h o r e m a i n o p p o s e d t o t h e A C A t o c o n t i n u e a d v o c a t i n g f o r l e g i s l a t i o n t o r e p e a l t h e A C A w i t h o u t h a v i n g t o f a c e t h e s i g n i f i c a n t f a l l o u t f r o m m i l l i o n s o f i m p a c t e d c o n s u m e r s , m a n y o f w h o m r e s i d e i n R e p u b l i c a n - d o m i n a t e d s t a t e s . A s t h e n a t i o n m o v e s c l o s e r t o t h e 2 0 1 6 P r e s i d e n t i a l e l e c t i o n , t h e p o s t - d e c i s i o n p o l i t i c a l r h e t o r i c s u g g e s t s t h e A C A w i l l l i k e l y c o n t i n u e t o b e a s i g n i f i c a n t c a m p a i g n i s s u e a n d t h a t R e p u b l i c a n s w i l l l i k e l y s p o t l i g h t p r e m i u m i n c r e a s e s a n d o t h e r u n p o p u l a r e l e m e n t s o f t h e A C A i n t h e i r m e s s a g i n g . B u t i n t h e n e a r - t e r m , t h e d e c i s i o n m e a n s t h e R e p u b l i c a n s c a n a v o i d a n i n t e r n a l s q u a b b l e a s t o h o w b e s t t o d e a l w i t h a n e w l y u n s u b s i d i z e d p o p u l a t i o n .
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