Health Care

King v. Burwell

King v. Burwell was a challenge to a key component of the Patient Protection and Affordable Care Act (“ACA”), a landmark law dedicated to achieving widespread, affordable health care.

Case Summary

The ACA provides that individuals can purchase competitively-priced health insurance on American Health Benefit Exchanges (“Exchanges”) that may be run by either the States or the federal government. It also authorizes a federal tax credit for low- and middle-income individuals who purchase insurance on the Exchanges. The Internal Revenue Service (“IRS”) issued a regulation confirming that the federal tax credit is available to all financially eligible Americans, regardless of whether they purchase insurance on a state-run or federally-facilitated Exchange.

The plaintiffs in King filed a lawsuit in the United States District Court for the Eastern District of Virginia, arguing that the ACA authorizes tax credits only for individuals who purchase insurance on state-established Exchanges.  The district court rejected the plaintiffs’ arguments and granted the government’s motion to dismiss the case. The plaintiffs in King appealed the decision to the United States Court of Appeals for the Fourth Circuit, and CAC filed an amici curiae brief in the Fourth Circuit on behalf of members of Congress who led the enactment of the ACA, including then-Senate Majority Leader Harry Reid and House Minority Leader Nancy Pelosi, as well as state legislators who served during the period when their state governments were deciding whether to create their own Exchanges.  The Fourth Circuit held that the IRS regulation confirming that tax credits and subsidies are available to individuals purchasing health insurance through the federal as well as state Exchanges was a “permissible exercise of the agency’s discretion.”  The plaintiffs asked the Supreme Court to hear the case, and it agreed to do so.

In the Supreme Court, we again filed an amici curiae brief on behalf of current and former members of Congress who were actively involved in the debates over the ACA and more than 100 current and former state legislators, all of whom were active in their states’ deliberations about whether to create their own state-based Exchange.  Our brief explained that the purpose of the tax credit provision is to facilitate access to affordable insurance through the Exchanges, and it demonstrated that there is no evidence in the legislative history of the ACA to suggest that Congress ever intended or communicated to the States that the availability of the tax credit depended upon the establishment of a state Exchange. In fact, we showed that the opposite was true: everyone, including amici members of Congress, understood that tax credits would be available to purchasers on all of the Exchanges. Further, state government officials never understood the tax credits to be limited to state-run Exchanges. Rather, as the state legislator amici knew from their own experiences, the States considered many factors in deciding whether or not to set up their own Exchanges, and the possibility that not setting up a state-run Exchange would result in the loss of tax credits to the State’s citizens was never one of those considerations.

On June 25, 2015, in a 6-3 ruling, the Court rejected the ACA’s challengers’ arguments, as CAC had urged. In an opinion authored by Chief Justice Roberts, the Court held that tax credits are available to individuals in states that utilize a federally-facilitated Exchange.  According to Roberts, because the phrase “an Exchange established by the State” is ambiguous as it relates to tax credits, the Court must look to the broader text and structure of the Act to determine the meaning of that phrase. The Court correctly ruled that, when the text of the ACA is considered as a whole, tax credits must be available to all qualifying citizens in every state; holding otherwise, the Court explained, would disrupt the interlocking reforms Congress put in place to achieve the law’s goal of affordable health care for all Americans. With this ruling, the Court affirmed the understanding of the ACA that has been held by state governments and members of Congress since the Act’s inception—that tax credits are available to eligible citizens for insurance purchased on any Exchange created under the ACA, be it state-run or federally-facilitated.

Case Timeline

More from Health Care

Health Care
U.S. District Court for the Northern District of California

California v. Trump

In California v. Trump, the U.S. District Court for the Northern District of California is considering whether the Trump Administration can lawfully refuse to reimburse health care insurers for cost-sharing reductions as required by the...
Health Care
U.S. Court of Appeals for the District of Columbia Circuit

United States House of Representatives v. Price

In United States House of Representatives v. Price, the United States Court of Appeals for the District of Columbia Circuit is considering whether the executive branch acted lawfully when it reimbursed health care insurers for...
Health Care
September 14, 2015

A Federal Judge’s Decision Will Make Washington Even More Dysfunctional

The New Republic
The House lawsuit over Obamacare is going forward. Is the Iran deal next?
By: Simon Lazarus
Health Care
June 27, 2015

John Roberts to America: I’m in Charge Here

The New Republic
When, just over two years ago, right-wing superlawyer Michael Carvin filed his first lawsuit seeking...
By: Simon Lazarus
Health Care
June 21, 2015

Justice Anthony Kennedy Might Use a Conservative Principle to Save Obamacare

The New Republic
Here are the three most likely outcomes in the Supreme Court case
By: Simon Lazarus
Health Care
March 3, 2015

Why the ACA challenge violates federalism

Balkinization
Opponents of the Affordable Care Act have been caught off guard by the possibility that...
By: Simon Lazarus