Congress Passed The Affordable Care Act to Improve Health Insurance Markets, Not to Destroy Them

Chief Justice John Roberts’ opinion in King v Burwell, which upholds health insurance subsidies for all eligible Americans regardless of where they live, virtually ends with the sentence quoted in the title of this essay. It is a declaration that brings to a close a 4-year epic journey of litigation designed to bring down the Affordable Care Act (ACA).

King was actually just one of a cluster of cases mounted simultaneously in several federal circuits across the United States, much in the way that NFIB v Sebelius,1 which tested the underlying constitutionality of the ACA, was the product of multiple litigation challenges to the law. Unlike NFIB, King was not designed to overturn the ACA on constitutional grounds. Instead, the litigation sought to cripple the law’s ability to operate, by barring access to federal premium subsidies that are a crucial part of an “interlocking” (in the words of the Chief Justice) statutory scheme designed to make health insurance accessible and affordable for millions of Americans without employer coverage and ineligible for public insurance.