The Supreme Court and the Fate of American Health Care

Mar 05, 2015 · 155 comments
John Babcock (Michigan)
As stated in this NYT editorial this case before the Supreme Court is based on the contention: "that when Congress passed the act in 2010, it simultaneously undermined the law’s central goal of affordable health care for all Americans by supposedly denying tax-credit subsidies to all residents in the 34 states where the federal government runs the health care exchange." My question is: Didn't the federal government already pay subsidies last year without denying tax-credit subsidies to any state, whether or not the state set up their exchange? Wouldn't you have expected some federal government push-back last year if that was what the government intended to do?
bearcat (seattle)
The Opinion piece suggests that Justice Kennedy will be the deciding vote, however, he has not been a dependable ideologue for the right or the left. That is why many commentators focused on Kennedy’s question during Pet’s. argument, to the effect:
Wouldn’t the offering of a tax credit to enrollees in States which set up exchanges, but not to enrollees in States that failed to set up exchanges, be coercive, and therefore unconstitutional?
Kennedy also suggests that failure to provide tax credits to all would create a death spiral in the health insurance market and defeat the purpose of the ACA for expanded coverage.
Kennedy's concerns about coercion are legitimate. But contrary to ACA's current framework, of mandating specific coverages, the ACA should be trying to encourage experimentation and diversity of coverages by allowing different choices in the State exchanges. Isn’t this the intended outcome of Federalism? Perhaps there are better untried methods for delivering universal healthcare.

To the second point it is not in the purview of the SCOTUS to determine the impact of legislation and tax subsidies on insurance markets; actuaries don’t interpret laws and the SCOTUS shouldn’t be trying to predict insurance consumer behavior.
RH (Hartford, CT)
Courts are often called upon to construe statutes that are poorly worded. Courts determine what the intent of the legislature was by examining the context and purpose of the statute. Reading a few words in isolation often leads to absurd results. Connecticut had a law that prohibited most people from owning highly dangerous animals. The statute included a long list of such animals, including lions. Problem was, the legislature forgot to list tigers, panthers and other wild cats. A person convicted of owning a wild cat that was not on the list of prohibited animals argued in the Connecticut Supreme Court that he/she was entitled to keep the animal because it was not specifically listed in the statute. The court held that this would lead to absurd results because it would defeat the very purpose of the statute, i.e., to prohibit people from owning such dangerous animals. The court construed the statute in such a way as to include the unlisted animals within the meaning of what the legislature intended to accomplish, thereby upholding the conviction. So, you see, courts can and do “save” statutes from infirmities in order to give effect to the intent of the legislature. It’s called “textualism,” an approach highly favored by Scalia as set forth in his book on statutory construction. Unfortunately, Scalia will likely “forget” this principle and focus only on the words challenged by the plaintiffs. He uses whatever method he can to achieve the results he desires.
Rasmus (copenhagen)
I find it tragic that you americans let the courts decide how to handle some of the most important issues in society. Questions like health care and gay marriage should be handled in congress by democratically elected politicians, not by lawyers and judges.
ND (ND)
The left has found that their ideas can't get approved in legislatures, so instead choose to use the courts to get what they otherwise couldn't achieve. Gay marriage and abortion are examples of this. They would never have gotten legislation to force gay marriage on the state of Massachusetts in the early 90's and the U.S. Congress would not have approved abortion on demand in 1973.
Paul '52 (New York)
Just last week the Court was faced with a case of a fisherman who clearly violated Sarbanes Oxley by destroying evidence (his undersized catch).
The court rewrote the clearly worded law to exempt that kind of violation, because SOX is concerned with Enron, and Lucent, and AIG, and not fish.

In the 30s Congress passed a law called Norris-LaGuardia that explicitly bars the federal courts from issuing injunctions against strikes. That law has never been amended or repealed.
In 1970 the Court issued a decision in a case called Boys Markets holding that in view of the purpose and intent of federal labor laws, inclusive of the National Labor Relations Act, federal courts can issue injunctions against strikes where a labor agreement contains an arbitration clause.

So the notion that there's no precedent for looking under the hood of a statutory scheme, inclusive of clear language, and reading its provision in light of the whole, and the intent of the whole,

that just isn't correct.
Arline Ostolaza (Alexandria, VA)
I hope Justice Kennedy prevails on this issue. The stakes have never been higher: millions of Americans will be without healthcare if the GOP arguments are upheld.
Ian Maitland (Wayzata)
Once again the NYT flunks American Government 101.

The question before the court is whether the ACA provides tax credit subsidies to exchanges run by the Federal Government despite the Act's plain language restricting such subsidies to exchanges created by states.

The Times's main argument is that without the subsidies many people will lose their medical coverage.

But even if that is true (which it isn't), it is none of the Supreme Court's business. Under our constitution, the power to make laws is expressly reserved to the Congress. The court's task is to faithfully interpret and apply the law, no matter if the New York Times thinks the results will be disastrous.

Once again, the Times's is urging that the Court disregard the Constitution and usurp the power of Congress. Once again, to get the political results it wants, the Times is willing to treat the basic constitutional constraints on the power of the government as meaningless technicalities. In so doing, it is leaving the door ajar for the eventual tyrant (or nine tyrants) who will find that, thanks to the Times, the Constitution offers no protection against their seizure of power.

As Bruce Fein has said, the right thing, done in the wrong way, is the wrong thing. And the Times consistently advocates the wrong thing.
J. Bolkcom (Buenos Aires)
Bush v Gore. Funny.
ND (ND)
The court correctly ruled that the Gore team and the FLA Supreme Court were not allowed to change the way FLA's electors were to be selected ex post facto. The FLA Supreme Court was already warned and yet proceeded full speed ahead (foolishly). Even Chief Justice Wells warned the majority (4-3) that the SCOTUS would overturn if they tried (again) to change the rules ex post facto. Also it wasn't 5-4 it was 7/2, it wasn't even close.
M.M. (Austin, TX)
We need the get rid of the Healthcare Industry. We need to put health insurance companies out of business by redefining healthcare for what it is: a strategic initiative of national importance.

We cannot be a viable nation if said nation cannot guarantee a healthy existence to the very people who define it. The country is us, each and every one of us.

The United States is its people, not its corporations. Healthcare is a service, not an industry. Treating as such is transacting in death, it's holding people hostage, it's extortion of the worst kind.

Single-payer healthcare for all. That's what we need. Making it happen is a daunting task that requires a government run by brave, honest men and women and we don't have any. What we have is a bunch of corrupt cowards doing their best to stuff their pockets.
Ian Maitland (Wayzata)
Has anyone else remarked on the fact that the NYT editorial board is prepared to embrace the very argument that it has denounced as a monstrous absurdity -- that the ACA deliberately withholds tax credits to federal exchanges -- so long as it gets the result it wants.

Justice Kennedy's theory -- that the ACA unconstitutionally coerces states -- rests on the assumption that the plaintiffs' interpretation of the law is the correct one.
Realist (Santa Monica, Ca)
I think that if you look at history, many times the pendulum swings one way until it comes back the other way. I think we're in such a period now. The Republicans can't logically defend their trickle down/job creator economic model. What worries me is that, after watching the Carter-Clinton=-Obama years, the Republicans will never accept a Democratic president as legitimate.
David Taylor (norcal)
I am so glad this issue arose because I was tired of listening to the "Benghazi" dog whistle. Now we get something fresh with the "Gruber" dog whistle!

Now, about legislating for the good of the country? It's at least 8-10 years out.
JK (San Francisco)
Americans need less expensive health care! Our leaders did not 'fix' the real 800 pound guerilla problem in the room. With nearly 18% of every dollar being spent on health care (and sure to rise even more); you would think our leaders would want to fix this problem. With European countries spending 10% to 12% on healthcare; you have to wonder why the average American is spending so much more than a citizen in these other countries.

While Obamacare may have helped folks with lower incomes; it still allowed doctors, hospitals and drug companies to stick it to the average American and take money from them that should be used for retirement, education and a better quality of life. To wit, the average German citizen does not go bankrupt because their child needed to go to the emergency room. In short, Congress and the President did not address the 'health cost' problem but rather gave insurance to folks that did not have it before.
Jim Waddell (Columbus, OH)
Only in the US are the uninsured charged the highest rates by doctors and hospitals. Can anyone explain how that makes sense?

And the only areas where health costs are declining are those subject to market forces (i.e. not covered by insurance.) Compare the decline in the cost of Lasik eye surgery since it was introduced to the every increasing costs of other surgical procedures.

Yes, Obamacare did nothing to address the major problem of health care in the US and may have worsened the cost problem.
W (NYC)
It may have. And yet it did not.
james ponsoldt (athens, georgia)
justice scalia (probably joined by justices alito and thomas) suggests that the drafters made a "mistake" in drafting that can and should be simply corrected by congress--change the "established by the state" language to include "or the federal government".

justice scalia is either dishonest or missing the point. of course this congress won't "fix" the statute--republicans in the house wouldn't let that happen.

but just as clearly, the congress that passed the statute wouldn't have meant or intended that only exchanges created by "states" within the federal government would get subsidies. instead, the word "state" means "State" as opposed to established privately: exchanges established by "government", generally.
Sequel (Boston)
I think Scalia was merely providing humorous cover for the reigning consensus among justices: Congress cannot pass such a legislative amendment any more than it could amend the Voting Rights Act, in spite of multiple invitations by SCOTUS -- hence the Shelby decision.

Which reduces to: Congress cannot fix ACA, and unless Congress has been given equivalent advance warnings as with the Voting Rights Act, SCOTUS can't either. "Answer is cloudy ... Ask again later ..."
William McQuaid (Seattle, WA)
Given the spirit of the health care law, overturning it is impossible even for our supremely corrupt supreme court. Either way, it still leaves callous insurance companies in charge of our health care. And still not a word about universal health care.
Republicans have no rational solution. Government accountants tell us the health care law will still bankrupt the country. Ironically Scalia is right; a corrupt supreme court decision to kill the law will finally enable us get the universal health care system we should have had years ago.
Amazingly, it turns out no one in the media or government seems to know anything about universal health care. Won't they be shocked to discover that for decades we've known that only universal health care is the solution*. You might think the media and government suffer from a rare disease that makes them believe the U.S. is the only country in the world. You would be right; all of our health care ills can be traced to this large scale corruption. Corruption can be the only thing that explains the gap between a majority of Americans supporting universal health care and us not having it.
Without question universal health care guarantees the best system at the best price.* Without question it's good old fashioned corruption that ensures government and the fourth estate won't talk about it. It's what they call making "business decisions".
Smells like business as usual.
*Source: OECD Health Care at a Glance 2013 pp. 46,48,49.
G Palmer (Dallas)
We can only hope common sense prevails and the Gov't loose its case which would no doubt cause problems but again with common sense we can come up with a MUCH better plan. One strictly for healthcare and not total control of we the people. I doubt the writer of this opinion has read the whole ACA but the TRUTH is healthcare is nominal after 2020. Taxation and Total control is what ACA is about. But remember "We Must Pass it to find out what's in it" The Socialist way but very Anti-American.
Joe (Seattle)
All legal and constitutional gyrations aside, how can anyone believe that adding to the rolls of the uninsured is somehow good for the country as a whole?
mikecody (Buffalo NY)
No, it is not good for the country. Fixing that, however, is up to Congress, not the Supreme Court. It is the job of the Court to enforce the law as written and passed by Congress; if that has unintended consequences it is up to Congress to fix them.
Peg (AZ)
"established by the state"

Even those who would give weight to this phrase have little to stand on.

All they have to do is focus on the legal meaning of the word "establish."

the word "establish" does not exclusively mean create, but it also means to ratify, or confirm.

So when some states decided to use the federal exchange - they actually established the federal exchange as the one to be used by state.

I mean, there is really no solid ground on this no matter how you approach the issue.
Peg (AZ)
Establish also means to found, recognize, confirm, or admit
Alan (Dallas)
except that numerous states have argued they want neither the subside nor the mandate for their citizens and sent letter long ago arguing as such, they clearly did not "establish" exchanges ... so .... do States have the sovereign authority to refuse to establish an exchange? look at the ruling regarding mandatory medicaid expansion which was deemed unconstitutional by a 7-2 margin as extensively coercive.
ecco (conncecticut)
the court will uphold the health care legislation, it cannot risk further revelation of its corruption (bush, v gore, citizens united, etc.), the issue it too close to the surface...but it's parent companies can rest easy the court and the congress will make amends and what amendments it can to further the promotion of the Special Interest over the "general Welfare," (see the preamble for that particular broken promise).
Steven Lee (New Hampshire)
Another instance of parsing the meaning of what is is. Think Clinton.
In this case the homonym state is at issue.
Does state mean The State meaning the government. If state meant state then it should be written 'the states'. In any case to take this case in order to parse meanings in order to serve the ideological goals of the neo-liberalism is the height of cynicism. Never mind R.B.Ginsburgs quip, no damage no standing, the hearing of this case on this basis looks like a setup.
If this stunt gets pulled off my god help us.
tpaine (NYC)
You have to love the NYT. Whatever did we do before ObamaCare?? How did we survive without Medicaid and then there's the mother of them all, Medicare. ALL at or near bankruptcy.
Better question to have ask is what should follow? May I offer a thought? "He who wears the shoe knows best where it pinches."
Burghound (Oakland, CA)
People died penniless without insurance or medical treatment.
David Lippincott (Portland, OR)
Not sure of the 87%. If it is the case, the number will decrease as more citizens with commercial insurance go to the exchanges and shop for better deals. Remember that those who signed up first had NO INSURANCE.
As a fairly wealthy person and physician, I welcome subsidized programs like the ACA. This does not "shift away my wealth". It preserves my wealth. Hospitals that treat the uninsured would make up the difference by charging me more for services. I would also pay more in taxes, direct or indirect, to support the uninsured who are disabled from complications of treatable diseases. There was a time when this was obvious to the informed in both major political parties.
JIm Thompson (Charlotte NC)
The issue is not about Healthcare it's about Health Insurance. The ACA has raised the cost of insurance for most Americans (many more to come once the delayed employer mandates take effect). Most of the enrollees so far are being added to Medicaid, and will receive poor care because of limited providers resulting from the cost controls that the single-payer system allows. So they will be insured but not properly covered. Even CNN has highlighted this issue as an issue of great concern, that they believe can only be fixed by dumping the ACA (hard to believe but they did). Once the employer mandate takes effect over 10 million (CBO estimate) will lose their current plan and get the new higher premium, higher out of pocket plans. So if the plan was to raise the cost to most while getting the semi-poor free insurance then it is working.
Burghound (Oakland, CA)
Millions have insurance now that were ineligible or unable to afford adequate coverage. Rate increases have been lower than predicted and the Act is working very well for most people.
working stiff (new york, ny)
Any decision by the Supremes that makes the Times editorial page white with rage is almost certainly a good decision.
Charles Race (Orlando)
ObamaCare was a hastily written and flawed act from the start- it was foisted on us by the White House and their chief order-takers, Harry Reid and Nancy Pelosi. Pelosi is now getting what she asked for- "let's pass this bill so we can find out what's in it." Well Nancy -your wish has been granted! This is why you're no longer Speaker of the House- because you and the Democrats lied to us. And what a great plan it is- my insulin prescription costs have gone from a $25 co-pay 2 years ago, to $600+ last year, to $1,360 for a 90-day refill. I can stomach this, don't like it, but I feel sorry for those less fortunate who have to pay these drug costs even with a subsidy. The Supremes don't make policy or try to interpret it- they apply the law as it is written. Obamacare was betting that the states would set up their own exchanges and only 13 did- the Dems knew this risk going in- it was no oversight!
Burghound (Oakland, CA)
You are wrong. The court interprets the law and the intent of the legislators. They assume the legislators intended the law to work as intended and be constitutional. Limiting the subsidies to states that were coerced into creating their own exchanges is unconstitutional and would offer no affordable insurance to states using the Federal exchange, defeating the whole purpose of the law.
DiogenesNJ (swamps of Joisey)
"... their chief order-takers, Reid and Pelosi"....

You have the pecking order wrong. Reid and Pelosi drove the ACA and its 2700 pages. Obama left it to them to draft it, he just rubber-stamped the result and took "credit".

Let us not forget that it was rammed through in lame duck session, before Scott Brown, elected in deep-blue MA to be the 41st vote to block it, could be seated. Will of the people? What's that?!?!

The ACA deserves to be replaced by a truly bipartisan health care bill. Prior to this, all major social legislation going back to Social Security was passed with a bipartisan majority. Only ACA was passed on a pure party line by 1 vote in the Senate.
JIm Thompson (Charlotte NC)
While your congratulating yourselves on the results of the ACA you might (as so-called champions of the poor and middle class) might read what CNN (hardly a right wing publication) had to say yesterday. You may not like their assessment. http://www.cnn.com/2015/03/04/opinion/atlas-obamacare-poor-middle-class/
Observer (Kochtopia)
The link you provided leads to an opinion piece by a conservative right-wing writer. It is not a news report, and it is not the opinion OF CNN.
dm (MA)
I hope Justice Kennedy's bringing up this point means that the conservative hard core of the SC will have to seriously confront it and if they plan to vote with the challengers.
lastcard jb (westport ct)
To all that are critical and say, why don't we have a better plan, read a little before you spout nonsense. Health insurance for all has been a goal way before Truman. We have what the Repugnicans would let us have. They gutted a great plan - first used by Romney in Mass. Yes we deserve better, but yes we deserve something. President Obama had the stones to get this done. We as a people all deserve health care as part of our tax expense. It would not be a triumph, actually for the American PEOPLE it would be a tragedy if the ACA was killed. We didn't settle for a "quick Fix" we took what we could to build on. Lets start with Truman " After FDR died, Truman became president (1945-1953), and his tenure is characterized by the Cold War and Communism. The health care issue finally moved into the center arena of national politics and received the unreserved support of an American president. Though he served during some of the most virulent anti-Communist attacks and the early years of the Cold War, Truman fully supported national health insurance. But the opposition had acquired new strength. Compulsory health insurance became entangled in the Cold War and its opponents were able to make “socialized medicine” a symbolic issue in the growing crusade against Communist influence in America." Obama did what Truman, Reagan, Carter, and the rest could not do. In that case he is the greatest President.
H. Torbet (San Francisco)
It appears that many people are of the opinion that the court should just do what is "right". This implies that if what is "right" is contrary to the law, the law should give way.

This is a dangerous way of thinking. In this country, the law must be paramount. If it is not, it is not the law. We might as well just accept anarchy if we are willing to accept caprice.

The operative theory is that if interests have a dispute under the law, and if they fight it out, what should emerge from the conflict is justice. The more people grind on it, the more likely the result will be a diamond.

Of course, the system is corrupt. Of course, judges have biases. Of course, money has more influence. Of course, it is hardly fair. However, we should not abandon our faith and our principles.

We should look at the fall of Obamacare as an opportunity to bring a proper medical care law to the people. Obamacare is a misguided effort to enrich the insurance companies and medical services industry. The people deserve better than a backroom deal on what should be considered a fundamental right in a modern society.
Robert (Out West)
The law in this country is not, and was never intended to be, mere sophistry.
Keith Ferlin (Canada)
You are right in your assessment of the ACA, but make sure you have a Democrat majority in Congress and a Democrat President before junking he ACA. For all of it's faults there are millions of your citizens that are now covered and it has made a critical difference and improvement of their lives. Get busy on getting out the vote in 2016.
Bob Bunsen (Portland, OR)
"We should look at the fall of Obamacare as an opportunity to bring a proper medical care law to the people."

Given the current "Let 'em die in a ditch" attitude of many conservatives, the fall of Obamacare would do nothing more than kick the can down the road for an unknowable number of years.

Perhaps the more effective solution would be to create and enact that proper medical care law, a feature of which will be repeal of the Affordable Care Act. At least that would leave something in place while the proper law is being hashed out.
Elliot (Chicago)
This entire case reminds me of Gore v Bush. By the time you have hundreds of election officials trying to ascertain the intent of a voter penciling in a bubble, you know something had gone terribly wrong in the process. Florida's election laws were poorly constructed and after the fact it was too late to fix them. As such we had calamity on the largest scale, and nine justices were forced to determine an election. The same goes for the ACA.

The ambiguity in the ACA occurred because the President and Democrats rushed an historic piece of legislation to a vote just 24 hours after publishing it. It's no wonder there a major flaw in the language. The SCOTUS, similar to Gore v Bush, is now forced to make a critical decision because the our government acted rashly and hastily in writing the legislation.

The moral of the story is for anything that important, give the legislation time and get buy in from both sides of the aisle. Democrats failed to give enough ground to Republicans in forming the legislation to garner one Republican vote. If they had received some Republican support, there would have been support now to amend the law to something more clear. The left can scream all it wants about how much they gave, but the proof is in the pudding. No Republican votes means no support.
Marky B (Brooklyn)
The left gave almost everything. Really. The fact remains that the final product was the Republican plan for many years before Obama decided to compromise on it (at several levels) and try things their way, at which point the Republicans ran screaming from their own plan. The fact that the Republicans couldn't support their own plan if it meant working with the President should in no way reflect on the law itself. It only reflects on them.

Also, the language in the law is clear. This case rides on a willful misinterpretation of it. I'm surprised it's even in a court of law.
Burghound (Oakland, CA)
The ACA IS derived from a Republican free-market idea, developed by the conservative Heritage foundation and adopted by Mitt Romney in Massachusetts. Personal responsibility used to be a Republican mantra, except for purchasing healthcare insurance, apparently. The GOP would not support any Federal plan and, to date, have proposed no alternative of their own.
Sanity (Hudson Valley)
What you really mean is we'll huff and puff and hope the house blows down.
Craig G (New York, NY)
The editorial states "which focuses on a single phrase — “established by the State” — embedded deep in a subsection of the act." In a 2700 page bill, isn't EVERYTHING buried deep in a subsection of the act?
Amused Reader (SC)
"Against all evidence and logic", apparently the Editorial Board does have the history on the ACA. Some of the earlier versions of the law had subsidies given to everyone regardless of the Exchange they were on by a Democrat forced the hand of the writers and said the states needed to be in on this as well and the Federal Government. In the negotiations the federal subsidies were dropped to do exactly what is being promoted, force the states to make exchanges.

A bad law is a bad law. SCOTUS should dismantle the law because it is not the IRS' duty to interpret the law but to administer it. The ACA is not vague nor is it a real question on the substance of the law. It was written poorly and deserves to be overruled.

Our society is based on the rule of law. When the rule of law is suspended because Congress writes a bad law and the Executive branch "fixes" it without going back to Congress, then we don't have representative government but have an elected monarchy.

And on the comments that millions will be hurt if the ACA subsidies are eliminated; thank your local Democrat Congressman. They have the power to work with the Republicans to fix this if they will. It may finally be the end of the "my way or the highway" Democrats and we will get back to the regular politics of compromise. You know a good deal is one where no one is happy at the end.
Sarah (Durham, NC)
I don't understand why most of the justices are always voting in favor of either the liberal or conservative political biases with which they are aligned. There are only ever 1 or 2 justices whose votes are unpredictable on any issue. You would think that serious constitutional questions, the kind that come before the Supreme Court, would be less predictable. In 2012 Justice Roberts voted in a "surprising" way and this time Justice Kennedy is bringing up issues in a way that "surprisingly" favors the other side. I wish all the Justices constantly "surprised" people with their legal thought so that we knew they were actually making good faith efforts to wrestle with the constitutionality of each issue.
H. Amberg (Tulsa)
I think it is significant that not one single state that declined the establishment of a FEDERAL marketplace within their states questioned whether the feds had the right to do so. Oklahoma is one of the states that declined and our attorney general and Howdy Doody doppelgänger Scott Pruit has joined in this suit. There are records of emails between him, our governor Mary "failing" Fallin and various state legislators discussing the declining of the $52 million to establish a state run marketplace on the basis of the optics of cooperation, but not the legality of the feds to do so. The same with the expansion of Medicaid, even though a moderate Republican state legislator pled for the poor and the hospitals and doctors that would be forced to care for them uncompensated. This suit is really without merit and I am disappointed that the SCOTUS even agreed to give it air time. I can only pray that the federal government prevails in this. My family is one of the many who have benefitted from availability of insurance via the federal marketplace.
june conway beeby (Kingston On)
It follows logically that the Republican party would want to kill a Health Care Bill that protects the lives of U.S. citizens with universal health care. Logical, because this action jibes so well with a political party that supports an unfettered guns-for-all political stance by a gun lobby that makes it easier to knock off children in schools.

Same crowd. Same mind set.
DCBarrister (Washington, DC)
The most stunning aspects of the media coverage of King v. Burwell is a complete refusal by news organizations like the Times to accept the basic tenets of law, and an equally complete refusal to assign any of the blame to Barack Obama.

This is Obama's law. Aptly named and flawed. I've read every article and opinion piece in the NYT since Obama announced his run for the White House in 2007. Mr. Obama has never been held accountable for any of his misdeeds, deceptions and in this case, debacles.

A Democrat-controlled Congress passed the ACA. Obama's inner circle of Ivy League elite and wealthy insurance company lobbyists wrote the bill. Yet the Times cries and bemoans the fate of healthcare, as if all of this is happenstance.

I'm a lawyer. We are trained to understand everything about cases like King v Burwell. There is absolutely no question about the law in this case--the ACA says what it says, in plain language, period. Context is a side argument and a distraction that does not apply when the intent and language of a law is so clearly stated. The ACA even has a glossary supplement that reiterates what "exchanges established by the state" means for the ACA.

The bigger question nobody is asking. How can Obama, marketed to us in 2008 as a genius and political messiah, not oversee his signature accomplishment? we are trained in law school to know and live due diligence. How could Mr. Obama allow language that undermines his law remain in the ACA?
William Case (Texas)
Many commenters continue to pretend that the term "State" as it is used in the Affordable Care Act can mean the federal government as well as one of the 50 states. However, like all laws, the ACA defines terms. The ACA specifically states that “In this title, the term ‘'State’' means each of the 50 States and the District of Columbia.” [124 STAT. 172]
Robert (Out West)
Which if true and accurate (and I doubt it) means that you are insisting upon reading those four "plain," words in the context of the whole Bill, not just on their own.
Burghound (Oakland, CA)
The intent of the lawmakers means more than the wording.
mikecody (Buffalo NY)
Burghound - the wording is what the Congress passed, not the intent.

“When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’
― Lewis Carroll, Through the Looking Glass
mj (seattle)
Chief Justice Roberts has a very difficult decision to make. When the history of this court is written, it will not be called the Scalia court or the Kennedy court but the Roberts court. If the court rules for the plaintiffs, millions will lose health insurance and there will certainly be some people who die because they will not be able to afford the healthcare they need and had under the ACA. These stories will certainly be reported in the press and the finger will be pointed at Justice Roberts if he sides with the plaintiffs. History is watching.
tom (Philadelphia)
It seems from my reading of reporting that the ACA has had a very positive
effect on health care. Cost's are declining, it's searches for healthcare that
includes good diagnosis and healthy living habits. All of our western nation
friends have some form of a health program. For a long time the greed in the
system has caused much pain and expense. I ask this question if your neighbor had a child that was very sick and very limited means, would you wan't them to have healthcare? My insurance before going on Medicare was close to $20,000.
My insurer raised our rates by huge amounts every year. And by the way Medicare is not free we pay for it. And most have backup insurance.
Who are we as as a nation. That is the question.
Lakeisha Jackson (Birmingham, AL)
We've certainly learned a few things about ACA.
Since 87% of the people enrolled in ACA receive government subsidies, it's pretty obvious that it's another huge wealth redistribution program.
If only President Obama had kept the promise he made to us as candidate Obama, we would have had 5 days to review the bill...and someone might have caught the phrase in question.
The ACA doesn't just state that health insurance subsidies are limited to "State Exchanges" in only one phrase. It states that in several different places.
Justice Kagan helped write the law, yet she didn't have enough professional integrity to recuse herself this time, either.
E C (New York City)
All insurance is wealth distribution.
Phil (Florida)
Factually incorrect.

Exchanges (capital letter E) defined as administered by the state OR by the federal government. Explicitly stated in the ACA. Case closed.

The fact that this bogus case made it to SCOTUS is another huge damning piece of evidence for the corruption of the justices (not really) who hold for the plaintiff.
Vincent from Westchester (White Plains)
The so-called "Affordable" Health Care Act simply caused my insurance to triple in price.

I hope that the Supreme Court sees that this bit of corporate welfare is not worth keeping.
Emory (Seattle)
Your insurance tripled in price because its coverage improved tenfold.
sixmile (New York, N.Y.)
Under the ACA as I understand it (and certainly in keeping with the obvious intent of the law), states were given the right and ample opportunity to set up their own exchanges -- but in no way did the law disempower the federal government from setting up its own to cover those living in states that decided not to set up a state exchange. The law did not say that if states do not create their own exchanges, residents of that state who qualify for a subsidy could not obtain it by purchasing insurance on the federal exchange. This case is bogus and seems to me not only a clear misreading of and attempt to subvert the ACA but also a frivolous (perhaps malicious is the better modifier) suit that ought never to have made it to the Supreme Court. And may well not have were it not for the politics and ideologies in play.
Bob Burns (Oregon's Willamette Valley)
I can't imagine the court finding for the plaintiffs. Aside from the merits, these guys are, after all, people, too. Roberts, if not the other conservatives, realize the outfall from a decision in plaintiff's favor. The court's entire credibility rides on this momentous decision.
DBA (Liberty, MO)
I'll say it again. The way the controversial phrase is expressed in the original legislation -- "established by the State" -- refers to the federal government. If it were plural, that might be different and a reference to the 50 states. But it's not. It's singular, referring to the federal government.
JIm Thompson (Charlotte NC)
Nice try but if that were true then they would not have written two separate sections (one for Federal Exchange and one for State Exchange).
Occupy Government (Oakland)
Ambiguities in the law are resolved by looking to legislative intent -- the congressional record, the votes, debates and even news accounts. If this matter were truly an issue, it would have come up sooner. Instead, it was left to a single clever lawyer to discover the blip. Those objecting now didn't object when the law was passed, when it was implemented, when they tried to repeal it 50 times, or when 12 million people signed up. If the Court is honorable, the law will stand.
effusive (palo alto, ca)
To Occupy Government: your last sentence says it all: "If the Court is honorable, the law will stand."
Lifesart (New York)
This is completely correct, and the Supremes should not have agreed to hear the case. Carvin et al may be the only ones who read through the entire law, trying every possible combination of sentences to find something to contest.
Observer (Kochtopia)
That, however, is a big IF.
Luke (Yonkers, NY)
I'll go out on a limb here and predict that the right-wingers on the court will restrain themselves, not out of compassion for the millions they would injure, but out of concern for GOP chances in the 2016 elections. A decision by the Court to gut the ACA just as the primary season gets into high gear will deliver to the Democrats an impassioned army of millions of committed voters who usually stay at home. The public will not take kindly to being forced to give up their healthcare at the behest of Republicans representing the interests of the one percent.
james ponsoldt (athens, georgia)
justices roberts and kennedy likely will do as you suggest, but justices scalia, alito and thomas are ideologues, pure and simple. they will vote again to strike down the law.
James A. Ritchie (New Castle, IN)
Not much matters less than what the "Supreme" Court says now. In case none of you have noticed, states all across teh country have stoppe dcaring, and have taken matters into their own hands on a number of issues, regardless of court rulings.

We're tired of paying through teh nose in order to support those who refuse to support themselves. Fortunately, one undeniable fact is on our side. Regardless of what teh court says, regardless of what Congress says, and regardless of what liberal wnt, this country cannot sustain the rate of taxation and spending we now have. No country on earth is invulnerable to debt, and our debt passed the critical limit five years ago.

There is no possible way to pay what we owe, or to prevent a massive and destructive amount of inflation when all teh useless money we're printing catches up with us. We are going to crash and burn, it's just a matter of when.

We can't tsop it from happening, we can only delay it, but liberals don't even want to do this. The liberal mantra is, "We want it, so you will pay for it." No, we won't. You have no idea what kind of hell is coming to this country, and by the time you find out, it's going to be far, far too late to stop it.
Patrick O'Loughlin (Madison, WI)
If there is blame to cast for "destroying" Obamacare, it should be on those who wrote the the so poorly, rather than those who interpret plain words plainly.
brupic (nara/greensville)
only in America is something that's taken for granted in most first world countries--health care for all, no capital punishment, reasonable maternity leave, gay marriage and military service, respectable vacation time and minimum wage standards--controversial.
Socrates (Verona, N.J.)
Also in 2012 ACA challenge by the right-wing, by a 7-2 vote, the Supreme Court allowed for the rejection of expanded Medicaid to the working poor, which every GOP-controlled state took advantage of by failing to expand Medicare coverage --- this impacted 8 million working poor nationwide in 'red' states --- these were the first official GOP Death Panels.

And now we have another lawsuit - a frivolous one made real by right-wing sedition - that seeks to double the size of GOP Death Panels.

In no other country will anyone ever witness such legal enthusiasm to destroy the health and well-being of the populace and the citizenry.

Exceptional American spite, malice and ill-will toward itself.

Thank you, Republican nihilism.
HANK (Newark, DE)
Should this case go badly for those previously disenfranchised from our for greed based healthcare delivery system, it should decide once and for all we are in fact an Ayn Rand dystopian society, having never been a righteous society, and never will be.
sixmile (New York, N.Y.)
The New Deal was strong redress of Randism and the injustices of the Gilded Age -- so wherever the road leads today I would not assert that our society has always allowed its dystopian tendencies to rule without antidote for the masses. Whether we remember that egalatarian part of our DNA is very much in question.
Bill (York, PA)
Why would anyone defend a law that punishes people who can't afford health insurance? Obviously the system is broken, but Obamacare is making things worse for working class people and the self employed. The system was poorly thought out.
HANK (Newark, DE)
Your're absolutely right, Bill. but what was left when half the congress said "Republicare," AKA the Emergency Room, was just fine for the demographic you mentioned.
fishlette (montana)
While I've not read the ACA, it seems to me the fact that it states that subsidies would be available for participants in state run exchanges does not mean that no subsidies would be available for states that did not have state run exchanges. To me, the fact that the ACA includes such a statement clearly means that the same subsidies would be available under state run plans as under federal run plans. Thus the words in question were obviously included so that persons who chose state run plans would be not excluded from subsidies.
Jack Nargundkar (Germantown, MD)
Hurray for Justice Kennedy’s remarkable insight for a hitherto unheard of interpretation of the implication those four infamous words – “established by the State.” He also appropriately reminded plaintiffs’ counsel, “Sometimes we think of things the government doesn’t.” It is hard to imagine, after pointing out this forced federal intrusion into states’ rights, that Justice Kennedy would then vote to support the plaintiffs’ argument in King v. Burwell?

More importantly, it is sad to see that there are interest groups so vested in the politics of our healthcare system that they would rather “destroy Obamacare” based on dubious legal interpretations than seek to improve it via legislative means. A previous Republican-controlled Congress passed a bill to save the life of a single individual on life support, but this one repeatedly votes (56 times at last count) to repeal Obamacare, on which over 11 million American lives depend, without offering any alternative remedies. This is tragic and very un-Christian to say the least.
Observer (Kochtopia)
You would think conservative lawyers would remember that in the Citizens United case, NEITHER side argued that corporations have the free-speech right to give unlimited money to political candidates.
Shotsie (ABQ, NM)
I think the plaintiffs would have a better argument if “established by the State” was really “established by the States” -

Also, good on Justice Ginsberg for bringing up the issue of the validity of the individual plaintiffs to actually prove their "injuries" - no damage, no lawsuit.

I can't wait for the future, tortured ruling....
William Case (Texas)
The ACA specifically states that “In this title, the term ‘State’ means each of the 50 States and the District of Columbia.” There absolutely no doubt about the meaning of the term as it applies to the ACA.

Why some disagree that three of the four plaintiffs have legal standing, the attorney for the White House has admitted that one of the plaintiff has standing. All it takes is one. Those who pretend that legal standing is an issue are dodging the issue. The court has agreed to hear the case
Fine Wine (Stamford, CT)
Its amusing how the Times has simply put away any notion that the law was written to specifically exclude the federal government from providing a tax subsidy when one of the chief designers of the legislation is on record saying otherwise in an effort to outsmart the states. Its the sort of rationalized logic the editors employ when they assume that the ACA subsidy system is a healthcare 'market' in danger of becoming a collapsing non market. You guys certainly didn't have these concerns last year when the ACA was indeed collapsing market policies and exposing people to hurried new coverage mandated by the ACA without patients existing doctors and hospitals. No, the Times considered that a good disruption.
soxared04/07/13 (Crete, Illinois)
"A serious constitutional problem" may, in short order, become of America's best-known phrases. One can begin to harbor a sense of justice here, as Justice Kennedy has sawn through the carapace of this unnecessary challenge to a flawed masterpiece of social legislation authored by a black president. One might reasonably expect Justice Kennedy to side with the plaintiffs, much as he did in 2012 when ObamaCare first came under assault. Yesterday, though, Justice Kennedy's question gave voice to the millions of beneficiaries of the ACA who have only the government as their advocate: those whose health and, perhaps, their very lives, are in peril if the Court's right-wing ultimately decide that these are lives that America can do without. Indeed, a handful of words in a law have swung the nation's attention, once again, to a ripped seam in the fabric of American society: what to do, and how to make it work. Justices Alito, Scalia, Thomas, and Chief Justice Roberts have apparently thought it beyond their duty to ask the simple question: how are the plaintiffs aggrieved by the ability of ten million Americans to secure health on a "state exchange?" The plaintiffs' attorneys are funded by unlimited shadow money, a shameless amount, designed only to destroy the gossamer threads of a social net they would just as soon see disappear forever.
KB (Brewster,NY)
Red state citizens rejoice ! you may witness the destruction of the ACA, you know it as Obamacare. Just what you've been demanding for the last six years.
Now, you can be rid rid of health insurance subsidies and the like which would have provided at least some financial protection from catastrophic illness and the like.

But like true Americans you said'NO". We can live on prayer. We won't take anything from the government because we are free to care for ourselves!
Well, to those of you in the 37 Red states,Your Republican congress people may have found a way to strip this unnecessary benefit away from young free your souls. which really don't need medical care anyway.

Now, you all must work to get your Republican congress people to help you rid yourself of those other three albatrosses: social security, medicare and medicaid. Just give the republicans another boost in 2016 and most of your dreams will come true.
John Edelmann (Arlington VA)
Well said!
Dee Dee (OR)
Thank you, KB. Sarcasm is the best way to respond in this instance. Love your last paragraph.
William Case (Texas)
Only 16 states set up ACA exchanges. Many of the states that opted not to set up exchanges are blue states.
Rick from NY (New York)
I don't care what your view on the ACA is, if the Supreme Court overturns it based on this issue it would be a travesty. I don't know how Carvin can keep a straight face when he presents his argument. It's obvious to me that the original intent was for the states to create their own markets and some chose not to and to default to the Federal market. None of them would have done this if they knew their constituents would be giving up the subsidies.
Occupy Government (Oakland)
It is not a question of overturning the ACA, but only whether the government may subsidize the cost of insurance. Far better for the government to pay straight up for health care than to pay insurers to dole it out for profit.
B (Minneapolis)
Here's blind justice - blinded by partisanship, that is.

The last time Justice Scalia heard an ACA case he ruled it unconstitutional for the federal government to withhold funding in order to coerce states into expanding Medicaid. Now - not so much - even after Justice Kennedy points out to him that withholding subsidies from states to coerce them to set up exchanges would be unconstitutional.

I guess when you are blind to justice - rather than blind to bias as the blindfolded lady with the scales - constitutionality is conditional.
Jane (New Jersey)
It would actually be a triumph for the American people if Obamacare is deemed unconstitutional. How dare Obama and the Democrats push through a lengthy, unread bill to serve their own political agendas. We Americans deserve and deserved better.

While it would certainly upset many citizens who are already enrolled, there are also those who have been hurt by its passing. So many middle class Americans have seen gross increases in their insurance premiums that pay for the subsidies, that they now have compromised their own healthcare to avoid further out of pocket expenses. Medical practices across the country have dwindled or sold out to hospitals as they no longer can stay afloat. And while more people have gained coverage, they have not gained any more access to care. Pitiful Medicaid reimbursements make it more expensive to run a medical practice.

We the American people should not have had to settle for a quick fix. Our citizens and our highly trained physicians deserve respect and a bill planned with care for all.
Dave Bloch (Alameda CA)
You are absolutely right that we deserved better; namely the single-payer system that would provide care without spending 30 percent of every dollar on billing and collection. Too bad the Republicans wouldn't hear of it.
John Edelmann (Arlington VA)
Just plain selfishness. The entire population of the country needs health coverage not just the well off. What happened to our civil society. It's now an all for me, to heck with everyone else society or poulation rather. Where were you when Obama wanted a National Plan like Medicare for all and had to compromise to this version with greedy republicans backed by Insurance companies and drug companies? Where were you when the drug companies lobbied so Medicare can't negotiate bulk or discounted purchases to save $? No where as long as you had your coverage, I am sure.
Orcrist (California)
We always hear about these people who were "hurt" by the ACA. I have yet to see one actually produced as an example who did not turn out to be some rabid Obama hater who merely refused to get a cheaper plan on the exchange.
Julian Fernandez (Dallas, Texas)
Once again, the notion that the United States is a confederation of 50 nation states, loosely bound by compact to each other and ultimately the deciders of their own fate is being used cynically to carry the water of the one percent. On almost every issue dividing us into camps one finds at its base the argument that the rights and directives of the governments in Montgomery or Albany or Austin are equal to or take precedent over those of the federal government in D.C. We must maintain this illusion that preserves the power and wealth of what are essentially the minor fiefdoms of the rich because... states' rights. I had assumed that we fought a rather bloody Civil War to decide this issue but find instead that we must litigate the question over and over again. Minimum wage laws, environmental regulations, labor laws, the adoption of national healthcare insurance or a realistic policy regarding personal drug use, marriage equality, and more are all held hostage to this notion that we are still a confederacy of independent states clinging to the Atlantic seaboard.

I'm a citizen of the United States. The fact that I live in an administrative entity controlled by yahoos emptying the public purse into their private pockets should not determine whether or not I can afford health insurance. When will it dawn on us that the 18th century is over and we are a single nation of 320-plus million?
karen (benicia)
Julian--I can't figure out why your point is not brought up more. The Civil War did solve this issue, and our country enjoyed some greatness and economic growth for many years as a result. Why these federalist yahoos have been given the chance to undermine this hard fought judicial and constitutional principal over time is beyond me.
ND (ND)
Being wrong for a long time (like the incorrect Supreme Court rulings that allowed unconstitutional laws like SS, Medicare, etc)
may give the impression, and maybe even the feeling of correctness, but it still doesn't make one right.

Your impression of the correct size and scope of the federal govt is a result of incorrect decisions being allowed to stand. Similar to how Essy v Ferguson was decided incorrectly and gave the impression that slavery was legal, when plainly it was not. This set in motion events which eventually corrected the obvious mistake. The same will happen (to a lesser extent than civil war one hopes) in time. Just wait till the wave of boomers about to retire and collect SS & Medicare hits and it take 2 millennials to pay for the unconstitutional benefits of the boomers. The worm will turn...
Ann Ente (Westchester, NY)
According to this editorial, "and costs for individuals would be even higher than they were before the law passed." How about the rest of us whose perfectly adequate insurance went much higher AFTER the law passed. For years our family chose not to have prescription coverage at an additional $1000 per year, we took no medicines, exercised, ate right and generally took care of ourselves. Now after ACA, our insurance premiums INCREASED by $5000 for worse coverage (NY already had, since 1994 no preexisting conditions). How did we also care for ourselves? - we didn't take expensive vacations, we don't have smart phones which are much more costly per month, we worked hard, we cooked healthy meals at home, we wear sweaters and keep the heat bill low, we have 11+ yr. old cars, saved for our children's education and left them without college debt, etc. Yes find a way to help the truly needy, but don't punish the rest of us for being responsible all our lives.
John Edelmann (Arlington VA)
I am confident you will change that tune when you need medicine that cost $10000 a month that a diet of Broccoli won't cure. This is not just about you its about all Americans having access to good healthcare. If you are lucky to be healthy- be happy.
MetroJournalist (NY Metro Area)
Thank you, Ann Ente. No one seems to believe us about the costs. Add to this the consolidation of hospitals, which are also buying out private practices. (But they solicit money as nonprofits!) I just interviewed a doctor for a magazine and he said the system is going to implode because of the economics of the health care system since the ACA.
H. Amberg (Tulsa)
I don't know about the plans available in NY but the Oklahoma plan I enrolled in does not include coverage for prescriptions. There were plans that did and plans available without. I opted for a high deductible to decrease my costs. When I first became unemployed, I had Cobra and a cost twice what I am now paying and when searching for a replacement plan, I was turned down by every company I sought to purchase a plan from. I was able to be included in my husband's employers plan at $900/month. Good coverage but not at a sustainable cost for our family of very modest means.
Robert Halleck (Del Mar CA)
It is so funny to see the lawyers bringing the case to the court wordsmith a law. Laws are written by administrative assistants and after 30 plus years inDC one thing I know is these young men and women can't find their you know what with both hands. They flat screwed up so it will be interesting to see how hardwired the court is.
Steve gadfly (Saint Paul)
Are you telling me that the people we send to Congress don't write the laws that they don't read before enacting ... what a country!
Christine_mcmorrow (Waltham, MA)
I'm rather resigned that those who would destroy the ACA would continue to do so even if this case does not overturn the guts of the law. Nothing less than full repeal will satisfy their insatiable desire to obstruct anything done by this president.

The fact they have no alternative save some weary generalities that point to a total return to the past of limited healthcare access and unfettered insurance plan greed does not seem to matter. Thus I'm glad Mr. Obama has refused to develop contingency plans. Why bother? The law was already watered down on so many issues that to try to fix a gutted law would be pointless.

Unless the court approaches this case with some sanity, we will really see how hopeless our country has become. When the ability of Congress to legislate results in nonstop lawsuits that end up in SCOTUS, we've really moved beyond the grand checks and balances designed by our founders

And that to me is one of the saddest aspects of this case. Another nail in the coffin of what was once a great republic.
M. J. Shepley (Sacramento)
Strangely news sources are cutting the argument from the original reports. of six words at the crux, to the mere four: established by the state.

The six words start with "AN exchange"..not THE. AN is a more open meaning, one that does not limit any state to tailoring its own system, but allowing (as it were) for any state to take a plan off the rack at the federal outlet store. Or, had private industry come up with a package to offer on the open market to any, even every, state, that too would have fit.

The "founders" (of ACA) in strict construction here understood that states might not be able to tailor there own plan, due to lack of time, lack of capability or resources, political gridlock (we assume no state would choose to let the poor get sick, then die and decrease the surplus population), so a default choice was included from the get go.

In not tailoring its own "the state" in effect ESTABLISHED the federal default as its "exchange". The rest is the sort of gutter wrestling down in the political muck the Supremes should keep the courts out of.
ngop (halifax, canada)
Mr. Carvin's thinly disguised argument is based on the dubious notion that Congress passed the ACA knowing that it would be limited to states that had their own exchanges. It seems far more likely that the disputed phrase was an unintentional ambiguity in the draft language, as even Mr. Scalia noted. This is just another underhanded attempt to overturn the spirit and intent of Obamacare.
ex-New Yorker (Los Angeles, CA)
"In the law, it says if the states don’t provide them, the federal backstop will. The federal government has been sort of slow in putting out its backstop, I think partly because they want to sort of squeeze the states to do it. I think what’s important to remember politically about this, is if you’re a state and you don’t set up an Exchange, that means your citizens don’t get their tax credits. But your citizens still pay the taxes that support this bill. So you’re essentially saying to your citizens, you’re going to pay all the taxes to help all the other states in the country. I hope that’s a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these Exchanges, and that they’ll do it."

- Jonathan Gruber, PPACA Architect, January 2012 (after the bill became law)

It was coercion, folks. Just like highway construction dollars.
Matt (RI)
The other serious constitutional question, which is hardly being discussed at all, is the lack of legal standing on the part of the plaintiffs, none of whom can prove they are materially harmed by the ACA in its current form. This case should not have even been heard.
James A. Ritchie (New Castle, IN)
Every taxpayer in the country has legal standing in this case, and this is what's being ignored. It's the taxpayer who once again is having money pulled out of his or her pocket to pay for someone else's wants or needs. This is simply wrong, whether it's health care, welfare, food stamps, or anything else.
Embroiderista (Houston, TX)
"This case should not have even been heard."

Agreed.

That won't stop John Roberts from legislating from the bench, though.
Atlant (New Hampshire)
James:

> Every taxpayer in the country has legal standing in this case,

That sort of broad standard is *NEVER* applied. By your reckoning, I could bring suit against the Federal Government for having conducted a blatantly illegal torture and detention program using my tax dollars but in the real world, if I attempted this, I'd be laughed out of court at every level for lack of standing.
j.s.sergio (Plantation Fla)
I am for the Affordable Care Act, But it didnt work for me,I am paying 938 per month for a policy that has a 6250 dollars deductible,and outside from a physical examination I must pay out of pocket 6250 before the Insurance Company pays anything,not being able to keep my Doctor and some of the Hospitals in my area are not in Network,I do not qualify for a subsidy since I am making to much money (54000 per year)But I am paying for a lot of people that qualify for a tax credit,maternity.pediatric dental for children.etc
Insurance Companies in Florida made more money last year than ever before,just by getting exorbitant premiums either privately or trough Health Care.gov,and denying services that were covered on my previuos policy(2500 ded and 647 per month) Its perfectly Ok for everybody to have Health Insurance, but is not Ok for me to pay for everybody else,
At 64 I may be in need for medical services at anytime. I can not afford not having insurance, but I have a poiicy that doesnt cover my inmediate needs and cost me over 50% more than I used to pay for a policy with Co Payments for Both Doctors and Hospitals, Please somebody tells me why I am forced to buy insurance that no longer fits my needs?
Kristin (Fredonia, WI)
Well let's see,you're 64 which means in a year I'll have to start paying for your health insurance. I sure hope you don't have hypertension,heart disease,cancer or diabetes because I don't so I don't see why I should have to pay to treat yours. Oh,BTW,I'm 69 and still working. I think your argument stinks.
Irene (Baltimore)
Js: I am 64 years old like you. ACA was a lifesaver for my husband and me because of a pre-existing condition. We pay $2000 per month for a platinum policy and receive no tax credits or subsidy. I keep working to pay to pay the premiums. But I do not complain, and neither should you. We will both be going on Medicare in the next year, which is supported by FICA taxes paid for by all working Americans.
John Edelmann (Arlington VA)
Pick a different plan, there are many with lower deductibles.
Mark (Atlanta)
The decision will clearly show which justices are ruling on political vs. legal grounds. Knowing that, it could very well be that the 4 conservative justices' questions were more for show.
Elliot (Chicago)
Great comment.

Yes, the liberal justices all interpret cases based solely on their legal merits, and give the utmost thought as to the proper ruling base.

The conservative justices however are all shills. They went to law school and served in public and private practice with esteem, made it through Senate review, but it was all a ruse. Once they got to the court, they would throw out their life's work ethic and simply judge cases by their political beliefs.

You've got it all figured out, Mark.
John Edelmann (Arlington VA)
Mark is correct. This case a waste of taxpayer's money is purely political. The republicans have been trying to kill ACA since it was enacted and this is all part of their narrow minded strategy and hate of the president.
Brian (Indiana)
Furthermore, if the entire schema of subsidies were invalidated, SCOTUS could just say that if this legislation is something the people want, there is still a way to achieve it through their elected representatives, they could still have it. All congress would have to due is try again, but avoid coercion that violates constitutional principle.

This is only a political problem for democrats, as, unfortunately for them, neither the people or a majority of their elected representatives, want this legislation.
Embroiderista (Houston, TX)
Which "people" are you referring to who don't want this legislation? The MILLIONS who will lose their healthcare coverage if the SCOTUS makes this a political issue? I'm pretty sure that those people actually DO want this legislation.

If they lose their healthcare, that won't be a problem for Democrats.

That will be a problem for Republicans who have yet to offer a viable alternative to the American people.
Brian (Indiana)
Actually, many of those millions who have ACA plans were forced into them, and they greatly preferred their pre-ACA plans, which, by the way, they were promised they could keep if they likes.

Those people don't want this legislation. Neither do the tens of millions who PAY for the subsidies.

Bottom line, polls consistently show that a majority of the American people don't like this legislation. Of course, since we are a federal republic, there is nothing to stop New York from doing something similar while Indiana does something quite different.
J (NYC)
Perhaps the most unintended piece of humor during the arguments was Antonin Scalia suggesting that if the Court does strike down the ACA, the Congress would fix it. The Congress that has voted 50+ times to repeal it, the Congress that uses words like "socialism" to describe it, the Congress that will not admit that their predictions of death panels and exploding costs were astoundingly wrong.

I wonder if Scalia actually believed what he said or is just trying to cover himself and the other judges who look likely to vote to invalidate the law?
MLH (Rural America)
It was not Justice Scalia's comment but Mr. Verrilli's response that elicited the laughter in the court.
Robert Demko (Crestone Colorado)
Scalia's statement that the Congress will fix it if SCOTUS breaks it will go down as the greatest irony since Marie Antoinette said let them eat cake.
Larry L (Dallas, TX)
The problem is that Scalia's definition of "fix" and everyone else's is quite different.
RK (Long Island, NY)
"Never underestimate the persistence of opponents of President Barack Obama’s signature legislative achievement, the Patient Protection and Affordable Care Act (ACA)," says David Cole in The New York Review of Books article, "Can they crush Obamacare?"

The conservatives are persistent, if nothing else. They went after President Clinton from the get-go and kept going and going. They are doing the same to President Obama. Nothing he does is good or right and they'll fight him to the end. Whether the venue is in the Superme Court or Congress doesn't matter, for the purpose is the same, defeat the other side, no matter what the cost or who it hurts. Sad, indeed!
Brian (Indiana)
There is another path Kennedy could take...

1. He could find that withholding subsidies from citizens of states that do not create their own exchanges is too coercive for the federalism ensconced in the Constitution...so clearly the law cannot be allowed to continue in that manner, and...

2. The statute plainly defines "state" by one of the 50 plus DC, and the statute also plainly states that subsidies are allowable to those who chose plans through exchanges established by the "state" and that this was EXACTLY what congress intended. He could FURTHER reasonably conclude that it is not SCOTUS' role to do the legislative branch's work.

3. If, as in 1 and 2, he concludes that subsidies to some states is coercive, AND that this was, in fact, Congress' intent, the remedy is not to prevent, as asked for by the plaintiffs, to invalidate the subsidies in only the states without exchanges, but to invalidate THE ENTIRE REGIME OF SUBSIDIES as contrary to the principles of federalism.
Jim (Long Island, NY)
Supposedly we pay members of congress in accordance with attracting the 'best and brightest'. If they are so bright, they should be able to write a law in clear and unambiguous language and they should also be able to read a law before they pass it. The law is so long, it would not have taken much tor them to insert a paragraph that said it an individual state did not enact an exchange, the federal government would fulfill those responsibilities. The authors did not include such a plain statement.
kwb (Cumming, GA)
NYT can bleat "against all evidence and logic", but Gruber's testimony provided both.
Orcrist (California)
Gruber has provided "testimony" now? And why is it relevant, when he is not a member of the body which voted on the law?
lastcard jb (westport ct)
If they derail the ACA be prepared for rioting in the streets - as it should be.
I would encourage every person who is now signed up to not take this lightly. Email, call, visit your representatives and make your position known. This is the worst thing the GOP has ever attempted to do, and they have done a lot of questionable things. The kicker to this whole things is they - The GOP - still has not presented a viable alternative other than - tough luck, I have mine now you don't have yours. Die.
Tammy Sue (Connecticut)
You're right, of course, but the sad truth is that there was no rioting in the streets after Bush v. Gore or Citizens United. Where is the outrage?
PB (CNY)
The Republicans can't come up with an alternative, since the ACA is based on the conservative Heritage Foundation's health insurance plan from decades ago and the MA health insurance plan passed during Romney's governorship.

But Obama was elected President twice, and the Republicans' idea of a political strategy is to make sure nothing good happens to Americans while a Democrat is in the White House.

So the Republicans were for the ACA before they were against it. Don't elect these people to office--they claim they don't like government and they have proved again and again they don't know how to govern.
John (Flagler Bch, Florida)
And "The Supremes" would feel how taking away millions of Americans their healthcare?

Would they regret the deaths or the bankrupt from the healthcare they took away?
Severna1 (Florida)
No, they don't think that way. Their job it to make final legal interpretations. They look at Congress's job to legislate and provide for the needs of the populace.
J Kurland (Pomona,NY)
Destroying the ACA would harm thousands, millions of Americans - especially when compared with the rest of the modern world. Young people might drop their insurance - who will pay their medical bills when they wreck their cars and themselves in poor driving. Or when they come down with meningitis. We taxpayers?? Oh no. Let them incur bills, their parents can pay, or they might received substandard treatment. And insurance costs going up for others so they can no longer manage - who pays for them and their children. The problem can be laid at the feet of those mean-spirited states that refuse to abide by the rules and set up the proper procedures. The fact is a single payer is the best and only way to have health insurance - Medicare For All with keeping those pharmaceuticals under control. Let's see just how much they actually pay for research and how much to advertise and pay off the medical field, hospitals, and their lobbyists to Congress. Why does this all remain such a mystery? I've been covered under Medicare for 13 years and doing well. I bought supplementary insurance to cover a small amount of extras and my medicines. Of course, I belong to a strong union who are honest, open, and extremely helpful to their workers and retirees. Worker need unions.
Hondo (Minnesota)
Professor Gluck should have a quick chat with Professor Gruber. The law was written with that provision to force states to develop exchanges or be punished through the withholding of federal subsidies.

The biggest bait & switch? How about "If you like your health care plan, you can keep it," President Barack Obama.

This is what happens when poorly written legislation that whipsaws the health insurance market is passed using parlor tricks along strict party lines. Shame on the President for his "lie of the year," shame on Pelosi for her "we need to pass it to find out what's in it," and shame on SCOTUS for playing politics.
Tinmanic (New York, NY)
Pelosi's famous "quote" has actually been distorted over time, and its meaning twisted. What Pelosi actually said was this "But we have to pass the bill so that you [i.e. the public] can find out what is in it – away from the fog of the controversy.” Meaning that the GOP put out so many lies about the ACA, and once the public actually experienced its benefits, they would understand it. See the full context at http://www.mediaite.com/tv/the-context-behind-nancy-pelosis-famous-we-ha....
shrinking food (seattle)
"If you like your health care plan, you can keep it," President Barack Obama.
the president was wrong, he admitted it, and apologized.
Reps continue to tell the same debunked lies (death panel) year fter year with not a peep from the rank and file.
RGV (Boston, MA)
I can think of quite a few lies by Obama, Pelosi and Reid that created a considerable amount of fog as well.
Peggy Jurow (Bloomfield)
If the "state" decides to use the federal exchange instead if establishing its own separate one, isn't then the federal exchange the one established by the "state" for its citizens?
DBA (Liberty, MO)
If SCOTUS should accept the flawed argument n King v. Burwell, my wife and I, like millions of other American citizens, will be officially screwed. People who fall into that huge gap in the years before one turns eligible for Medicare will be dropping like flies. It cost us nearly $600 a month for COBRA coverage when I lost my last job (due to an acquisition and being considered redundant). She signed up for the ACA and based on our income, received a good tax credit for a middling insurance policy that would have cost nearly $750 month. If the ACA goes away because this case, we'll be up a creek for medical coverage until she qualifies for Medicare. And of course, given our Republican Congress, they'll next go after Medicare -- because they basically work for the billionaires who fund their reelections rather than the constituents they're supposed to represent.
Charles Marean, Jr. (San Diego, California, USA)
I don't get how all those people are there in the picture. How are they paying their bills, including Obama care? Supposedly their boss sells things and then pays them. It doesn't make sense that that would work. There is no guarantee that it would work that I've ever heard of. The economy makes no sense. The news said there are 10, 000 homeless in San Diego and 50,000 in San Francisco. How is it everyone isn't homeless? I find that the economy is unsafe to be too stressful.
PagCal (NH)
Roberts is back where he was before. If he dumps Obamacare, then we will be back to the strong and clarion call for Single Payer health care. (His call. He saw the light last time, and will so again, IMHO.)
jeff jones (pittsfield,ma.)
The 'Roberts Court signature is still relevant to the Chief Justice.History will judge and record,on that basis.He should way that very real legacy...and Plessy v Ferguson,infamy.
Mark (Cheboyagen, MI)
It is unbelievable that the SCOTUS would take up this case. Following the challengers logic would be the same as saying 'It depends on what the definition of is is'. For the SCOTUS to walk past the millions of Americans who would once again be without healthcare and the deaths and suffering it would cause, not to mention the financial hardship placed on the middle class, who would once again find their premiums skyrocketing would be an act of political arrogance.
Larry Eisenberg (New York City)
I hope Linda Greenhouse is right
Scotus avoids a baleful blight,
Roberts or Kennedy
Acting judicially,
Will spare us perfidious plight!