Obamacare has survived -- again.

In a major win for the Obama administration, the Supreme Court held in a 6-3 decision that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal exchanges.

Chief Justice John Roberts wrote for himself, Justice Anthony Kennedy and the four liberal justices. Justice Antonin Scalia wrote the dissent, joined by Clarence Thomas and Samuel Alito.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote in the majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."

In a dissent, Scalia said "we should start calling this law SCOTUScare," referring to the two times the Court has saved the law.

The ruling staved off a major political showdown and what would have been a mad scramble in some states to set up their own healthcare exchanges to keep millions from losing healthcare coverage.

Challengers to the law argued that the federal government should not be allowed to continue doling out subsidies to individuals living in states without their own healthcare exchanges and a ruling in their favor would have cut off subsidies to 6.4 million Americans, absent a congressional fix or state action.

The ruling is a huge victory for President Barack Obama who nearly saw those four words in the Affordable Care Act throw his signature achievement into chaos.

The income-based subsidies are crucial to the law's success, helping to make health insurance more affordable and ultimately reducing the number of uninsured Americans, and shutting off the subsidy spigot to individuals in the 34 states that rely on exchanges run by the federal government would have upended the law.

Congress would have had to amend the Affordable Care Act to fix the "established by the state" language -- a politically treacherous and likely untenable action in a Republican Congress -- or governors in the 34 states without their own exchanges, most of them Republicans, would have had to establish their own exchanges -- another tough ask.

Obama's signature law was once again saved by an unlikely hero: Chief Justice John Roberts, a conservative who has now twice shielded the law from being gutted.

Roberts took heat from conservatives in 2012 when he first saved the law from a major constitutional challenge in a decision that stunned pundits and politicos across the ideological spectrum. The Chief Justice on Monday once again joined the court's four liberal justices in upholding the law.

Just 16 states and the District of Columbia have set up their own health insurance marketplaces, which left millions of residents in the 34 states that rely on exchanges run by the federal government vulnerable to the Supreme Court's ruling.

Challengers had argued that the words "established by the State" clearly barred the government from doling out subsidies in the 34 states without their own healthcare marketplaces.

They said that Congress limited the subsidies in order to encourage the states to set up their own exchanges and when that failed on a large scale, the IRS tried to "fix" the law.

"If the rule of law means anything, it is that text is not infinitely malleable, and that agencies must follow the law as written—not revise it to 'better achieve' what they assume to have been Congress's purposes," wrote Michael Carvin, an attorney for the challengers.

But it was Solicitor Generald Donald B. Verrilli, Jr. who won over the justices, arguing that Congress always intended the subsidies be available to everyone -- regardless of the actions of their state leaders.

Verrilli warned in court briefs that if the challengers prevailed, the states with federally-run exchanges "would face the very death spirals the Act was structured to avoid and insurance coverage for millions of their residents would be extinguished."

Lower courts had split on the issue. The U.S. Court of Appeals for the District of Columbia invalidated the IRS rule while the Fourth Circuit Court of Appeals ruled in favor of the Obama administration.

In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined—“to say what the law is.” Marbury v. Madison, 1 Cranch 137, 177 (1803). That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan.

Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt.

Having transformed two major parts of the law, the Court today has turned its attention to a third. The Act that Congress passed makes tax credits available only on an “Exchange established by the State.” This Court, however, concludes that this limitation would prevent the rest of the Act from working as well as hoped. So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare.

 Frazzled wrote:
SCOTUS rightfully sidestepped this. Read between the lines of Robert's opinion-this is a political issue and SCOTUS doesn't do political issues. If the Republicans want to overturn this they have to get off their butts and actually overturn it. hah hah no safety for you!

 Ensis Ferrae wrote:
Question... not really relevant to the topic at hand but, have there ever been a SCOTUS heard case that was ever unanimously decided?

OgreChubbs wrote:
Why do people hate paying for health care to help out other people.

OgreChubbs wrote:
Why do people hate paying for health care to help out other people. It is kinda like give 5% your income so you can help a sick person and they can help you when you get sick.

I find alot of people who hate this type of things tend to not have alot of sick people in their life or have alot of money to burn.

 jasper76 wrote:

OgreChubbs wrote:
Why do people hate paying for health care to help out other people. It is kinda like give 5% your income so you can help a sick person and they can help you when you get sick.

I find alot of people who hate this type of things tend to not have alot of sick people in their life or have alot of money to burn.

Despite some social programs, we live in a society with a very strong current of "every man for himself", where many view susbidies for the poor as theft from themselves, or as they say in te talking head shows these days, "wealth transference".

OgreChubbs wrote:
Why do people hate paying for health care to help out other people.

 jasper76 wrote:
For my part, this whole law stinks of corruption from the insurance lobby. The medical insurance industry as such should become extinct, and we should follow the lead of the civilized world and come up with a single payer system.

Maybe after Republicans begin seeing the writing is on the wall that the ACA isn't going anywhere, they will begin to see the merits of single payer, but since they too are beholden to the insurance companies, I doubt it.

 whembly wrote:

 jasper76 wrote:
For my part, this whole law stinks of corruption from the insurance lobby. The medical insurance industry as such should become extinct, and we should follow the lead of the civilized world and come up with a single payer system.

Maybe after Republicans begin seeing the writing is on the wall that the ACA isn't going anywhere, they will begin to see the merits of single payer, but since they too are beholden to the insurance companies, I doubt it.

Yup. Totally agree on all parts.

Also, keep in mind, Health Insurance Mandates is not Healthcare. It's a form of corporate welfare.

 CptJake wrote:

OgreChubbs wrote:
Why do people hate paying for health care to help out other people.

That is a piss poor way to frame the question. The real question is why do people hate being forced to pay.

My wife and I give freely and generously to several charity and other organizations which help people in need, and have given to individuals we knew who needed help. I do not mind paying to help others. I hate being told to give more to an inefficient federal bureaucracy at threat of incarceration or confiscation of my property. Look at the VA as an example of federally run health care. And the answer to inefficiency and out right corruption seems to always be Give Them More Money. That money must be taken from folks who work hard to earn it.

OgreChubbs wrote:

 CptJake wrote:

OgreChubbs wrote:
Why do people hate paying for health care to help out other people.

That is a piss poor way to frame the question. The real question is why do people hate being forced to pay.

My wife and I give freely and generously to several charity and other organizations which help people in need, and have given to individuals we knew who needed help. I do not mind paying to help others. I hate being told to give more to an inefficient federal bureaucracy at threat of incarceration or confiscation of my property. Look at the VA as an example of federally run health care. And the answer to inefficiency and out right corruption seems to always be Give Them More Money. That money must be taken from folks who work hard to earn it.

Relax mate i do not really mind what ya do. I just think everyones deserves to not feel pain as best we can help. I have different morals then alot of people and beliefs i except that some people when told to pay get mad, i just guess i am in a postion in my life where helping others is fiscal avable and i am well off. Hell my brother didn,t like my old apartment and bought me a house lol.

 CptJake wrote:

 whembly wrote:

 jasper76 wrote:
For my part, this whole law stinks of corruption from the insurance lobby. The medical insurance industry as such should become extinct, and we should follow the lead of the civilized world and come up with a single payer system.

Maybe after Republicans begin seeing the writing is on the wall that the ACA isn't going anywhere, they will begin to see the merits of single payer, but since they too are beholden to the insurance companies, I doubt it.

Yup. Totally agree on all parts.

Also, keep in mind, Health Insurance Mandates is not Healthcare. It's a form of corporate welfare.

To be fair, if you force them to flatten out risk pools you should have to increase the participation in the pool to help alleviate the costs. Those mandates are the mechanism to encourage participation from those who would otherwise not. And that mechanism provides the incentive to the companies to play the gov't game. Not that there were reluctant to do so anyway, offer them MOAR and a federally ensured payoff and they are smart to accept it.

 whembly wrote:

 CptJake wrote:

 whembly wrote:

 jasper76 wrote:
For my part, this whole law stinks of corruption from the insurance lobby. The medical insurance industry as such should become extinct, and we should follow the lead of the civilized world and come up with a single payer system.

Maybe after Republicans begin seeing the writing is on the wall that the ACA isn't going anywhere, they will begin to see the merits of single payer, but since they too are beholden to the insurance companies, I doubt it.

Yup. Totally agree on all parts.

Also, keep in mind, Health Insurance Mandates is not Healthcare. It's a form of corporate welfare.

To be fair, if you force them to flatten out risk pools you should have to increase the participation in the pool to help alleviate the costs. Those mandates are the mechanism to encourage participation from those who would otherwise not. And that mechanism provides the incentive to the companies to play the gov't game. Not that there were reluctant to do so anyway, offer them MOAR and a federally ensured payoff and they are smart to accept it.

It's a risk pool per insurance plan, per state.

Pre/Post ACA, the risk pools themselves have remained largely unchanged (and in some case, worst off). Hence why the premiums\deductables are trending in the wrong direction.

That's the problem. Hence, why the idea of allowing a plan to be sold across state lines (ie, being portable) has appeal, since it's the easiest way to "flatten out the risks" as you put it.

Prestor Jon wrote:

 whembly wrote:

 CptJake wrote:

 whembly wrote:

 jasper76 wrote:
For my part, this whole law stinks of corruption from the insurance lobby. The medical insurance industry as such should become extinct, and we should follow the lead of the civilized world and come up with a single payer system.

Maybe after Republicans begin seeing the writing is on the wall that the ACA isn't going anywhere, they will begin to see the merits of single payer, but since they too are beholden to the insurance companies, I doubt it.

Yup. Totally agree on all parts.

Also, keep in mind, Health Insurance Mandates is not Healthcare. It's a form of corporate welfare.

To be fair, if you force them to flatten out risk pools you should have to increase the participation in the pool to help alleviate the costs. Those mandates are the mechanism to encourage participation from those who would otherwise not. And that mechanism provides the incentive to the companies to play the gov't game. Not that there were reluctant to do so anyway, offer them MOAR and a federally ensured payoff and they are smart to accept it.

It's a risk pool per insurance plan, per state.

Pre/Post ACA, the risk pools themselves have remained largely unchanged (and in some case, worst off). Hence why the premiums\deductables are trending in the wrong direction.

That's the problem. Hence, why the idea of allowing a plan to be sold across state lines (ie, being portable) has appeal, since it's the easiest way to "flatten out the risks" as you put it.

How does the federal govt make individual insurance plans portable across state lines? Each state has its own insurance laws, standards and oversight. Different insurance companies operate in different states. The federal govt can't just come in and overrule existing state laws.

I agree interstate portable insurance would be cheaper, but I don't see how you get past all the obstacles that prevent it. It's like trying to make car insurance portable across state lines.

“In this instance, the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”

 whembly wrote:

Prestor Jon wrote:

 whembly wrote:

 CptJake wrote:

 whembly wrote:

 jasper76 wrote:
For my part, this whole law stinks of corruption from the insurance lobby. The medical insurance industry as such should become extinct, and we should follow the lead of the civilized world and come up with a single payer system.

Maybe after Republicans begin seeing the writing is on the wall that the ACA isn't going anywhere, they will begin to see the merits of single payer, but since they too are beholden to the insurance companies, I doubt it.

Yup. Totally agree on all parts.

Also, keep in mind, Health Insurance Mandates is not Healthcare. It's a form of corporate welfare.

To be fair, if you force them to flatten out risk pools you should have to increase the participation in the pool to help alleviate the costs. Those mandates are the mechanism to encourage participation from those who would otherwise not. And that mechanism provides the incentive to the companies to play the gov't game. Not that there were reluctant to do so anyway, offer them MOAR and a federally ensured payoff and they are smart to accept it.

It's a risk pool per insurance plan, per state.

Pre/Post ACA, the risk pools themselves have remained largely unchanged (and in some case, worst off). Hence why the premiums\deductables are trending in the wrong direction.

That's the problem. Hence, why the idea of allowing a plan to be sold across state lines (ie, being portable) has appeal, since it's the easiest way to "flatten out the risks" as you put it.

How does the federal govt make individual insurance plans portable across state lines? Each state has its own insurance laws, standards and oversight. Different insurance companies operate in different states. The federal govt can't just come in and overrule existing state laws.

I agree interstate portable insurance would be cheaper, but I don't see how you get past all the obstacles that prevent it. It's like trying to make car insurance portable across state lines.

Congress can simply pass a law stipulating that any plans in the Exchange are portable.

Done.

 riverhawks32 wrote:
I would be much more receptive to Republican healthcare platforms if they realized that we've had this law for 3 years and reforming/changing it would be more cost effective than trashing it and completely building another law. Who doesn't agree that healthcare should be available/affordable for all? Let's take this opportunity given by the SCOTUS and fix the system to more cost effectively reach its intended effect.. Just my 0.02$

Prestor Jon wrote:

 whembly wrote:

Prestor Jon wrote:

 whembly wrote:

 CptJake wrote:

 whembly wrote:

 jasper76 wrote:
For my part, this whole law stinks of corruption from the insurance lobby. The medical insurance industry as such should become extinct, and we should follow the lead of the civilized world and come up with a single payer system.

Maybe after Republicans begin seeing the writing is on the wall that the ACA isn't going anywhere, they will begin to see the merits of single payer, but since they too are beholden to the insurance companies, I doubt it.

Yup. Totally agree on all parts.

Also, keep in mind, Health Insurance Mandates is not Healthcare. It's a form of corporate welfare.

To be fair, if you force them to flatten out risk pools you should have to increase the participation in the pool to help alleviate the costs. Those mandates are the mechanism to encourage participation from those who would otherwise not. And that mechanism provides the incentive to the companies to play the gov't game. Not that there were reluctant to do so anyway, offer them MOAR and a federally ensured payoff and they are smart to accept it.

It's a risk pool per insurance plan, per state.

Pre/Post ACA, the risk pools themselves have remained largely unchanged (and in some case, worst off). Hence why the premiums\deductables are trending in the wrong direction.

That's the problem. Hence, why the idea of allowing a plan to be sold across state lines (ie, being portable) has appeal, since it's the easiest way to "flatten out the risks" as you put it.

How does the federal govt make individual insurance plans portable across state lines? Each state has its own insurance laws, standards and oversight. Different insurance companies operate in different states. The federal govt can't just come in and overrule existing state laws.

I agree interstate portable insurance would be cheaper, but I don't see how you get past all the obstacles that prevent it. It's like trying to make car insurance portable across state lines.

Congress can simply pass a law stipulating that any plans in the Exchange are portable.

Done.

I don't see how that solves the problem that there are insurance companies offering health insurance in some states that don't have a license to operate in other states. If the NC Dept of Insurance hasn't licensed a company to provide health insurance in NC, how does a federal law change that? If Acme Insurance is licensed to operate in Ohio but not NC, how does Congress suddenly make a plan from Acme Insurance in Ohio, available to me in NC? Congress can't just make state laws and regulations disappear.

 CptJake wrote:

OgreChubbs wrote:

 CptJake wrote:

OgreChubbs wrote:
Why do people hate paying for health care to help out other people.

That is a piss poor way to frame the question. The real question is why do people hate being forced to pay.

My wife and I give freely and generously to several charity and other organizations which help people in need, and have given to individuals we knew who needed help. I do not mind paying to help others. I hate being told to give more to an inefficient federal bureaucracy at threat of incarceration or confiscation of my property. Look at the VA as an example of federally run health care. And the answer to inefficiency and out right corruption seems to always be Give Them More Money. That money must be taken from folks who work hard to earn it.

Relax mate i do not really mind what ya do. I just think everyone's deserves to not feel pain as best we can help. I have different morals then alot of people and beliefs i except that some people when told to pay get mad, i just guess i am in a position in my life where helping others is fiscal available and i am well off. Hell my brother didn't like my old apartment and bought me a house lol.

Are you not confident in your ability to figure out how to best allocate that money to help those you feel are in need? Or are you of the opinion the gov't can best decide that for you? If you are, are you happy with how efficiently they do so?

 whembly wrote:

Also, from the the majority opinion:

“In this instance, the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”

and

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”

Oi... that's a heck of a precedent.

OgreChubbs wrote:

 CptJake wrote:

OgreChubbs wrote:

 CptJake wrote:

OgreChubbs wrote:
Why do people hate paying for health care to help out other people.

That is a piss poor way to frame the question. The real question is why do people hate being forced to pay.

My wife and I give freely and generously to several charity and other organizations which help people in need, and have given to individuals we knew who needed help. I do not mind paying to help others. I hate being told to give more to an inefficient federal bureaucracy at threat of incarceration or confiscation of my property. Look at the VA as an example of federally run health care. And the answer to inefficiency and out right corruption seems to always be Give Them More Money. That money must be taken from folks who work hard to earn it.

Relax mate i do not really mind what ya do. I just think everyone's deserves to not feel pain as best we can help. I have different morals then alot of people and beliefs i except that some people when told to pay get mad, i just guess i am in a position in my life where helping others is fiscal available and i am well off. Hell my brother didn't like my old apartment and bought me a house lol.

Are you not confident in your ability to figure out how to best allocate that money to help those you feel are in need? Or are you of the opinion the gov't can best decide that for you? If you are, are you happy with how efficiently they do so?

Not really no, I have no way to view what needs to be taken care of due to the large amount of people in need and no way to gauge it myself. Same as they tell me they are starving in Africa I have no way to know if that's the truth just second and third hand knowledge, which is why we work good in a group. I can't figure it out because I have alot of other things to do. So if we put someone in charge of taking care of that in exchange we can keep his life working by giving him money to do that job. Then he gives me money to do my job of growing food .

This is why I think we should take care of everyone best we can because with out each other we don't get to far. Guess I can say I just trust in most people to do the right thing most of the time.

P.S. i was wondering if someone could figure this out for me.

If the money spent on trying to repeal this health care bill from the judges to the courts to all the paper work was spent towards paying for that health care bill how low would everyone's payments be?
Say instead of trying to repeal it they put the money towards everyone's healthcare to help lower the cost.

OgreChubbs wrote:


If the money spent on trying to repeal this health care bill from the judges to the courts to all the paper work was spent towards paying for that health care bill how low would everyone's payments be?
Say instead of trying to repeal it they put the money towards everyone's healthcare to help lower the cost.

 cincydooley wrote:

Additionally, the ACA has had significant impact on the health care premiums and deductibles for those that already had health care prior to the ACA. It's costing lots of (mostly middle class) people lots of money in lots of different ways. Anecdotally, we give significantly less to the charities we used to because our deductibles, on average, have gone up between 150%-220% in the last three years, and in some specific cases (childbirth) even more.