this is abour ACA act attached is the artical if needed please see questions 1-5

Discussion Questions 1. In his recent book, The Court and the World: American Law and the New Global Realities (2015), Justice Stephen Breyer writes, "Ordinarily, when deciding difficult textual questions, courts look to text, history, tradition, precedent, purpose, and consequences." In your opinion, which opinion-the majority's or that of the dissent- addresses those factors more satisfactorily? 2. Can you explain the logic behind the chief justice's holding, and is it persuasive to you? 3. What are the "death spirals" he refers to? 4. What effect has the ACA had on the percentage of the population without health insurance since the individual and employer mandates began to take effect in 2014? 5. What is the current status of Medicaid expansion in your state and nationwide? Chapter 3: Health Reform. Access to Care, and Admission and The Court Decides C st NCA ple, sk King . Burwell 135 S. Ct. 2480 (2015) Roberts, Chief Justice The Patient Protection and Affordable Care health Insurance in those states could buy Act adopts a series of interlocking reforms it, and insurers could not deny coverage or designed to expand coverage in the indi. charge a higher premium because of preexist- vidual health insurance market. First, the Act ing conditions. The opinion continues.) burs insurers from taking a person's health The guaranteed issue and community rat. into account when deciding whether to sell ing requirements achieved (the goal of mak- health insurance or how much to charge. ing insurance available to alll, but they had Second, the Act generally requires each per- an unintended consequence: They encour- son to maintain insurance coverage or make aged people to wait until they got sick to buy a payment to the Internal Revenue Service. Insurance. Why buy insurance coverage when And third, the Act gives tax credits to certain you are healthy, if you can buy the same cov- people to make insurance more affordable. erage for the same price when you become In addition to those reforms, the Act ill? This consequence-known as "adverse requires the creation of an "Exchange" in selection"-led to a second: Insurers were each State-basically, a marketplace that forced to increase premiums to account for allows people to compare and purchase the fact that, more and more, it was the sick Insurance plans. The Act gives each State the rather than the healthy who were buying opportunity to establish its own Exchange, insurance. And that consequence fed back but provides that the Federal Government will into the first: As the cost of insurance rose, establish the Exchange if the State does not. even more people waited until they became This case is about whether the Act's ill to buy it. Interlocking reforms apply equally in each This led to an economic death spiral." State no matter who establishes the State's As premiums rose higher and higher, and Exchange. Specifically, the question pre- the number of people buying insurance sank sented is whether the Act's tax credits lower and lower, insurers began to leave are available in States that have a Federal the market entirely. As a result, the num- ber of people without insurance increased dramatically 1 ... In 1996, Massachusetts adopted the Here the Chief Justice summarizes what he guaranteed issue and community rating calls a "long history of failed health insur- requirements and experienced similar results. But in 2006, Massachusetts added two more ance reform" including two related concepts reforms: The Commonwealth required indi- viduals to buy insurance or pay a penalty, and it gave tax credits to certain individuals to ensure that they could afford the insurance they were required to buy. The combination d how do mdigent for pult, Exchange. that several states adopted in the 1990s: a guaranteed issue" requirement and a "com- munity rating" requirement. Together these reforms meant that anyone who wanted (continued) Access to Cane Admission and Discharge 94 The lof Healthcarl 95 of these ther-insurance market regulation coverage manfate, and tak credits-educed the uninsured rate in Mas the Nation have a Federal Exchange rather than a Exchange, The Act initially provides that The parties dispute whether Section 365 Credits shall be allowed for any Authores tax credits for individuals who are in an insurance plan through a Federal Exchange within the State." sachusetts to 2.6 perc by far the lowest in taxpayer. 26 U.S.C. 36(a). The Act the provides that the amount of the credit Exchange Petitioners argue that a federal depends in part on whether the papers enrolled in an insurance plan through Exchange established by the State de by the State under 142 U.S.C. 510 and that the IRS Rule therefore contradicts ABS Rule referred to earlieris law because Exchange and Federal Exchanges are equi provides that each State shall... establish The Affordable Care Act addresses taxon in what is now Section 368 of the Revenue Code.../Refer to the table Wides that each State shall... establish an Burwellon p. 100 for the texto American Health Benefit Exchange for the other provisions referred to in the State... Hut if the State chooses not to That table is provided to enable the to follow Chief Justice Roberts's mother da Section o11 provides that the sec try'...establish and operate such pichange is not an Dachange established By the perseuch Exchange Section of the Secretary to establish and out the same Exchange that the Sule was directed to establish under 150g of the ACAL Bon 368. The Government responds that the Sections... wortis, State to implement these provisions, the IRS promulgated a rule that made for the phrase "an Exchange established by the Sent--they meet the same credits vellable to applicable taxpayers State under 42 U.S.C. 180311should be ments per the same function who enrolled in an insurance plan through ad to include Federal Exchanges serve the same proses. Sed on Exchange regardless of whether the It is our task to determine the Federal changes established by the cored reading of Section 368. f the statu ent sovereigns Sections and to do HHS. At the time the opinion was written tory language is plain, we must enforce it not so that they offer in any meaningful 34 states had opted to let S set up the according to its terms. But oftentimes the way. A federal change there counts waning-or ambiguity-of certain wants particular Exchanges. The petitioners in the Exchanger under Section or phrases may only become evident when Second, we must determine whether case were four residents of Virginia who do paced in context." Quoting an earlier a federal changes tablished by the not want to buy health insurance. They Supreme Court case./So when deciding State" for purposes of Section that (@) Virginia's exchange, which was whether the language is plain, we must read outset, it might seen that a Federal Escharge up by HHS does not quolllyes "en Exchange the words in their contest and with a view to cannot full this requirement. After all, the established by the State" under helt place in the overall statutory scheme Act defines to meech of the they should not receive tax credits wit Our duty, after all, is to construe statutes, 50 States and the District of Columbia cost of buying insurance would exceed eight out the credits the cost of insurance would hot Isolated provisions." definition that does not include the federat percent of income for a large number of be more than 8 percent of their income on Government. But when main content with Individuals, which would exempt them from A (d) therefore they are exempt from the a view to its place in the overall statutory the coverage requirement. The ACA exempts viduol mandate. These arguments filed at We begin with the text of Section 360, Asel whene," the meaning of the phase ustab from the del mondote anyone who both the trial court and Court of Appeal evant here, Section 360 allows an individual lished by the State is not so clea. would have to spend more than 8 percent of to receive tax credits only if the individual Milwame on health bence! Circul levels; however, in a similar case These provisions serest that the M molls in an insurance plan through Court of Appeals for the D.C. Circular may not always the phrase "bished Dchange established by the State under 142 by the State" in its most naturale. Thus, the tax credits are available only for a U.S.Ctoolin other words, three things the meaning of that phrase may not be as In addition to those three reforms, the Act must be true: First, the Individual must enroll den as appears when read out of content. requires the creation of an "Exchange in In an insurance plan through an Exchange Third, we must determine whether a fed each State where people can shop for insur Second, that Exchange must be established eral Exchange is established under U.S. ince, usually online. An Exchange may be by the State." And third, that Exchanger must Col" This too might seem a Created in one of two ways. First, the Act 11 he established under 142 U.S.C 180il ment that a Federal Exchange cannot full We address each requirement in tur. because it is Section 1804 that is the sec an American Health Benefit Exchange...for First, all parties agree that a Federal retary when to establish and operate such the State. Second, if a State nonetheless Exchange qualifies as an Exchange for Exchange. But here again, the way different choose not to establish its own Exchange. purposes of Section 368. Section 1031 pro provisions in the statute Interact sugests the Act provides that the Secretary of Health otherwise and Human Services "shall...establish and The Act defines the term "Exchange to operate such Exchange within the State." mean an American Health Benellt Exchange The issue in this case is whether the Act's tax credits are available in States that plex analysis.) The describes the Air provision (1) of the ground issue and community Anting requirements (2) al for individuals to have insur ance or material to the IRS - the mandheld NFB. Sebe A & of the book and the Mboleave more affordable These three reforms are closely inter d... Congress found that the guan anteedise and community rating require ments would not work without the coverage requirement. And the coverage requirement would not work without the tax credits. The son is that without the tax credits, the exchanges. This split of opinion between no appellate circuits led to the Supreme Court deciding to grant certioral "Statutory Provisions Referred to in and the tax credits. So it Wands to reason E with a Federal Exchange, and key create the Conpesas meant for those provisions to wply in every Sate as well. Serta of the opinion is omitted.) D Chapter Health Reform, Access to Care, non isch compatible with the rest of the law.Chinge 1988 Supreme Court decision. Here, the ALTA. dating without the federal sub Act tells the secretary to estabish and oper foryscheme compels us to reject petition the changes would not operate as Congressitended and may not operate to the role of the legislature, and take care not congue the guaranteed issue and com mingguirements applicable in every State in the Nation. But those requirements only work we combined with the coverage que Outrole is more confined to say what the 5. Marbury v. Madison, 1 Cranch 137. 96 The Law at Healthcare Administration 97 established under section 18. if we 1776). That is used in some as than import that definition into Section of the In . in ate such American Health Benefit Exchange Interpretation because it would des to do what it has done. Ata angol established under section soi. That sus the individual insurance market in any Sue Wisation demands a fait understanding of gests that Section 18041 authorizes the Sec the legislatheplan retary to establish an Exchange under Sec very death spirals that Congress desire Congress passed the Affordable Care tion 10, not for not only) oder Section the Act to avoid. See New York State Dept. of to improve health Insurance marks, 18041. Otherwise, the Federal Exchange, by Social Servs Dublin 43 U.S. 405,419-470 to destroy them. It will possible must definition, would not be an "Exchange" at all (973) We cannot interpret federal stades Interpret the Act in a way that is consistent This interpretation of under 42 U.S.C negate their own stated purposes. with the former, and evidstheater Section 51Bosat fits best with the statutory context As discussed earlier, Congress based the 36B can fairly be read consistent with what All of the requirements that an Exchange must Affordable Care Act on three major ons wees Congress's plan, and that is the meet are in Section 1, so it is sensible to first, the guaranteed issue and community Pioners arguments about the plain mean reading wedol regard all Exchanges as established under that ing requirements, second, a requirement that The judgment of the United States Court provision. In addition, every time the Actuses Individuals maintain health insurance cover of Section 615 are strong. But while the of Appeals for the fourth Circultis meaning of the phrase "an Exchange estab- the word "Exchange the definitional prove ape or make a payment to the IRS, and the Ished by the State under 42 U.S.C. Silloir Affirmed sion requires that we substitute the phrase the tax credits for individuals with household may seem plain when viewed in isolation, "Exchange established under section Bogi." Incomes between 100 per cent and 400 per cha reading turns out to be "untenable JUSTICE SCALIA, with whom JUSTICE if Federal Exchanges were not established cent of the federal poverty line, in a state that light of the statute as a whole. In this THOMAS and JUSTICE ALITO, dissenting under Section 1, therefore, literally none establishes its own Exchange these three Instance, the content and structure of the The Court holds that when the patient of the Act's requirements would apply to them. reforms work together to expand insurance Acompels to depart from what would Protection and Affordable Care Ac says May the Act repeatedly uses the phrase coverage. The guaranteed issue and com otherwise be the most natural reading of the "Exchange established by the Star established under U.S.C. Silloin situ. nity rating requirements ensure that anyone pertinent statutory phrase means Exchange established by the State ations where it would make no sense to distin: can buy insurance the coverage require Belunce on content and structure in statu or the Federal Government. That is of course guish between State and federal Exchanges. A ment creates an incentive for people to do w tory interpretation is a subtle business, call quite absurd, and the Court's 21 pages of Federal Exchange may therefore be considered before they get sick and the tax credits - ing to treat warness test what professes explanation make it no lesso, one established under U.S.C.518" is hoped - male insurance more affordable to bene rendering becomes creation and ... This case requires us to decide ... The Affordable Care Act contains more Together, those reforms "minimize...dverse moted interpretation of legislation becomes whether someone who bosince than a few examples of inartful drafting to selection and broaden the health insurance station itself." Palmer, Massachusetts, 308 an Exchange established by the Secretary cite just one, the Act creates the separate risk pool to include healthy individuals, which 4.5.79.83 (1939). For the reasons we have gets tax credits. You would think the answer Section 1563. See 124 Stat, 270, 911, 912.) will lower health insurance premiums, twin, howeve such reliance is appropriate in would be obvious - obvious there would Anyway, we must do our best, bearing Under petitioners' readings, however, the Biscase, and leads us to conclude that Section hardly be a need for the Supreme Court to in mind the fundamental canon of statutory Act would operate quite differently in a State allows tax credits for insurance purchased construction that the words of a statute must with a Federal Exchange. As they see lone hear a case about it. In order to receive any hany Exchange created under the Act. Those money under 536, an individual must enoll be read in their context and with a view to of the Act's three major reforms -- the tar their place in the overall statutory scheme." Se are necessary for the Federal Exchanges in an insurance plan through an "achang credits -- would not apply. And a second major established by the State. The Secretary of reform--the coverage requirement --would not Date and to avoid the type of calamitous result Health and Human Services is not a State # that Congress plainly meant to wold apply in a meaningful way.... The combina Given that the text is ambiguous, we must tum So an Exchange established by the Secre tion of no tax credits and an ineffective cover tary is not an Exchange established by the to the broader structure of the Act to determine age requirement could well push a states indi: the meaning of Section 368. "A provision that vidual insurance market into a death spiral may seem ambiguous in isolation is often clari In a democracy, the power to make the Exchange fied by the remainder of the statutory scheme It is implausible that Congress meant the Act low tests with those chosen by the people. to operate in this manner. See National Feder- ... because only one of the permissible mean tion of Independent Business w. Sebelus. 567 U Ines produces a substantive effect that is 5. (2012) (SCALIA, KENNEDY, THOMAS, and State-which means people who buy health Insurance through such money under 5568 Words no longer have meaning it an Exchange that is not established by a State 5. What is the current status of Medicaid expansion in your state and nationwide? and discharge 99 funds associated with the Medicaid expan- of the law, the Court today has turned its ation to a third. The Act that Congress passed makes tax on The Court decision rellects the philoso sed by a thet ply that should endure whatever seperti distortions it takes in order to perele af the path that philosophy hores the mallin restored as posed few in the statutory Powers" enumerated in the whale og Corsress thinks that the present design of the son. Having transformed two major parts States to set up their own Exchanges. And it Act works well enough, it could do nothing Congress could also do something else to the entirely abandoning the structure of the Affordable Care Act. The Court's insistence Exchange established by the State. This oaking a choice that should be made by Congress both agandues judicial power and would prevent the rest of the Act from work Court Attend Arican people's decision to give congress 4. What effect has the ACA had on the percentage of the population without health Insurance since the individual and employer mandates began to take effect 2014 Comitation. At. Lt. They made Congress, Court, responsible for both making w and mending them. This court holds only the judicial power--the power to pro the law as Conpress has enacted it, we lack the prerogative to repair laws that do Not work out in practice, just as the people tack the ability to throw us out of office if as they dislike the solutions we concoct. We the must always remember, therefore, that "Tour task is to apply the text, not to improve upon LlQuoting a 1989 case... alice as belo show It is not our place to judge the quality met de petition is met heard of who of the care and deliberation that went into what dan change this or any other law. A low enacted by voice sted by the Seas Exchange vote with no deliberation whatever is fully as State the feel binding upon us as one enacted after years of study, months of committee hearings, and weeks of debate. Much less is it our place to and with Wining cortimation make everything come out right when Con- het 'Exchaelished by the State press does not do its job properly. It is up to what toomes, the Court Congress to design its laws with care, and it weater ble met scor interpretation is up to the people to hold them to account ir they fail to carry out that responsibility the conclusion that cogni Rather than rewriting the law under the pretense of interpreting it, the Court should by the have left it to Congress to decide what to do Je pages the precious state changes of Congress values above about the Act's limitation of tax credits to and citie Select the and ches everything else the Act's applicability across oldesde cering.coba category ble in every Exchange, Ifit prizes state the country, it could make tax credits avail Involvement in the Act's implementation, it furabile Ae win that the majority's bopic gate the economic consequences predicted by could continue to limit tax credits to state Bachanges while taking other steps to mit- the Court. I Congress wants to accommodate both goals, it could make tax credits available everywhere while offering new incentives for Court, however, concludes that this limitation encourages congressional lassitude. ing as well as hoped. So it rewrites the law Today's opinion changes the usual to make this will everywhere. We rules of statutory interpretation for the sake should start calling this law SCOTUScare of the Affordable Care Act. That, alas, is not Perhaps the best Protection and novelty. In National Federation of Inde. Affordable Care Act was the during pendent Business V. Sebellus, 567 U.S. status of the Social Security Act of the Toft- this Court revised major components of the Hartley Act perhaps not. But this Court's statute in order to save them from unconsti- Two decisions on the Act will surely be butionality. The Act that Congress passed pro remembered through the years. The somer vides that every individual "Shall maintain saults of statutory Interpretation they have Insurance or else pay a "penalty." This Court, performed (penalty means tax,"further however saw that the Commerce Clause Medicald payments to the State means does not authorize a federal mandate to buy only incremental Medicaid payments to the health insurance. So it rewrote the mandate: State, "established by the State means not cum-penalty as a tax established by the State) will be cited by The Act that Congress passed also litigants endiessly, to the confusion of honest requires every State to accept an expansion Jurisprudence. And the cases will publish for of its Medicald program, or else risk losing all ever the discouraging truth that the Supreme Medicaid funding. This Court, however, saw Court of the United States favors some lans that the Spending Clause does not autho over others, and is prepared to do whatever it rize this coercive condition. So it rewrote takes to uphold and assist its favorites the law to withhold only the incremental I dissent. Discussion Questions 1. In his recent book. The Court and the World: American Low and the New Global Realities (2015). Justice Stephen Breyer writes, "Ordinarily, when decling difficult textual questions, courts look to text, history, tradition, precedent purpose, and consequences. *** in your opinion, which opinion the majority or that of the dissest- addresses those factors more satisfactorily? 3. Can you explain the logic behind the chief justice's holding and is it persuasive to you! 3. What are the death spirals" he refers to? of the app ice" and gesit inte of the inde from the age of and he omalee concludes with elowing er Discussion Questions 1. In his recent book, The Court and the World: American Law and the New Global Realities (2015), Justice Stephen Breyer writes, "Ordinarily, when deciding difficult textual questions, courts look to text, history, tradition, precedent, purpose, and consequences." In your opinion, which opinion-the majority's or that of the dissent- addresses those factors more satisfactorily? 2. Can you explain the logic behind the chief justice's holding, and is it persuasive to you? 3. What are the "death spirals" he refers to? 4. What effect has the ACA had on the percentage of the population without health insurance since the individual and employer mandates began to take effect in 2014? 5. What is the current status of Medicaid expansion in your state and nationwide? Chapter 3: Health Reform. Access to Care, and Admission and The Court Decides C st NCA ple, sk King . Burwell 135 S. Ct. 2480 (2015) Roberts, Chief Justice The Patient Protection and Affordable Care health Insurance in those states could buy Act adopts a series of interlocking reforms it, and insurers could not deny coverage or designed to expand coverage in the indi. charge a higher premium because of preexist- vidual health insurance market. First, the Act ing conditions. The opinion continues.) burs insurers from taking a person's health The guaranteed issue and community rat. into account when deciding whether to sell ing requirements achieved (the goal of mak- health insurance or how much to charge. ing insurance available to alll, but they had Second, the Act generally requires each per- an unintended consequence: They encour- son to maintain insurance coverage or make aged people to wait until they got sick to buy a payment to the Internal Revenue Service. Insurance. Why buy insurance coverage when And third, the Act gives tax credits to certain you are healthy, if you can buy the same cov- people to make insurance more affordable. erage for the same price when you become In addition to those reforms, the Act ill? This consequence-known as "adverse requires the creation of an "Exchange" in selection"-led to a second: Insurers were each State-basically, a marketplace that forced to increase premiums to account for allows people to compare and purchase the fact that, more and more, it was the sick Insurance plans. The Act gives each State the rather than the healthy who were buying opportunity to establish its own Exchange, insurance. And that consequence fed back but provides that the Federal Government will into the first: As the cost of insurance rose, establish the Exchange if the State does not. even more people waited until they became This case is about whether the Act's ill to buy it. Interlocking reforms apply equally in each This led to an economic death spiral." State no matter who establishes the State's As premiums rose higher and higher, and Exchange. Specifically, the question pre- the number of people buying insurance sank sented is whether the Act's tax credits lower and lower, insurers began to leave are available in States that have a Federal the market entirely. As a result, the num- ber of people without insurance increased dramatically 1 ... In 1996, Massachusetts adopted the Here the Chief Justice summarizes what he guaranteed issue and community rating calls a "long history of failed health insur- requirements and experienced similar results. But in 2006, Massachusetts added two more ance reform" including two related concepts reforms: The Commonwealth required indi- viduals to buy insurance or pay a penalty, and it gave tax credits to certain individuals to ensure that they could afford the insurance they were required to buy. The combination d how do mdigent for pult, Exchange. that several states adopted in the 1990s: a guaranteed issue" requirement and a "com- munity rating" requirement. Together these reforms meant that anyone who wanted (continued) Access to Cane Admission and Discharge 94 The lof Healthcarl 95 of these ther-insurance market regulation coverage manfate, and tak credits-educed the uninsured rate in Mas the Nation have a Federal Exchange rather than a Exchange, The Act initially provides that The parties dispute whether Section 365 Credits shall be allowed for any Authores tax credits for individuals who are in an insurance plan through a Federal Exchange within the State." sachusetts to 2.6 perc by far the lowest in taxpayer. 26 U.S.C. 36(a). The Act the provides that the amount of the credit Exchange Petitioners argue that a federal depends in part on whether the papers enrolled in an insurance plan through Exchange established by the State de by the State under 142 U.S.C. 510 and that the IRS Rule therefore contradicts ABS Rule referred to earlieris law because Exchange and Federal Exchanges are equi provides that each State shall... establish The Affordable Care Act addresses taxon in what is now Section 368 of the Revenue Code.../Refer to the table Wides that each State shall... establish an Burwellon p. 100 for the texto American Health Benefit Exchange for the other provisions referred to in the State... Hut if the State chooses not to That table is provided to enable the to follow Chief Justice Roberts's mother da Section o11 provides that the sec try'...establish and operate such pichange is not an Dachange established By the perseuch Exchange Section of the Secretary to establish and out the same Exchange that the Sule was directed to establish under 150g of the ACAL Bon 368. The Government responds that the Sections... wortis, State to implement these provisions, the IRS promulgated a rule that made for the phrase "an Exchange established by the Sent--they meet the same credits vellable to applicable taxpayers State under 42 U.S.C. 180311should be ments per the same function who enrolled in an insurance plan through ad to include Federal Exchanges serve the same proses. Sed on Exchange regardless of whether the It is our task to determine the Federal changes established by the cored reading of Section 368. f the statu ent sovereigns Sections and to do HHS. At the time the opinion was written tory language is plain, we must enforce it not so that they offer in any meaningful 34 states had opted to let S set up the according to its terms. But oftentimes the way. A federal change there counts waning-or ambiguity-of certain wants particular Exchanges. The petitioners in the Exchanger under Section or phrases may only become evident when Second, we must determine whether case were four residents of Virginia who do paced in context." Quoting an earlier a federal changes tablished by the not want to buy health insurance. They Supreme Court case./So when deciding State" for purposes of Section that (@) Virginia's exchange, which was whether the language is plain, we must read outset, it might seen that a Federal Escharge up by HHS does not quolllyes "en Exchange the words in their contest and with a view to cannot full this requirement. After all, the established by the State" under helt place in the overall statutory scheme Act defines to meech of the they should not receive tax credits wit Our duty, after all, is to construe statutes, 50 States and the District of Columbia cost of buying insurance would exceed eight out the credits the cost of insurance would hot Isolated provisions." definition that does not include the federat percent of income for a large number of be more than 8 percent of their income on Government. But when main content with Individuals, which would exempt them from A (d) therefore they are exempt from the a view to its place in the overall statutory the coverage requirement. The ACA exempts viduol mandate. These arguments filed at We begin with the text of Section 360, Asel whene," the meaning of the phase ustab from the del mondote anyone who both the trial court and Court of Appeal evant here, Section 360 allows an individual lished by the State is not so clea. would have to spend more than 8 percent of to receive tax credits only if the individual Milwame on health bence! Circul levels; however, in a similar case These provisions serest that the M molls in an insurance plan through Court of Appeals for the D.C. Circular may not always the phrase "bished Dchange established by the State under 142 by the State" in its most naturale. Thus, the tax credits are available only for a U.S.Ctoolin other words, three things the meaning of that phrase may not be as In addition to those three reforms, the Act must be true: First, the Individual must enroll den as appears when read out of content. requires the creation of an "Exchange in In an insurance plan through an Exchange Third, we must determine whether a fed each State where people can shop for insur Second, that Exchange must be established eral Exchange is established under U.S. ince, usually online. An Exchange may be by the State." And third, that Exchanger must Col" This too might seem a Created in one of two ways. First, the Act 11 he established under 142 U.S.C 180il ment that a Federal Exchange cannot full We address each requirement in tur. because it is Section 1804 that is the sec an American Health Benefit Exchange...for First, all parties agree that a Federal retary when to establish and operate such the State. Second, if a State nonetheless Exchange qualifies as an Exchange for Exchange. But here again, the way different choose not to establish its own Exchange. purposes of Section 368. Section 1031 pro provisions in the statute Interact sugests the Act provides that the Secretary of Health otherwise and Human Services "shall...establish and The Act defines the term "Exchange to operate such Exchange within the State." mean an American Health Benellt Exchange The issue in this case is whether the Act's tax credits are available in States that plex analysis.) The describes the Air provision (1) of the ground issue and community Anting requirements (2) al for individuals to have insur ance or material to the IRS - the mandheld NFB. Sebe A & of the book and the Mboleave more affordable These three reforms are closely inter d... Congress found that the guan anteedise and community rating require ments would not work without the coverage requirement. And the coverage requirement would not work without the tax credits. The son is that without the tax credits, the exchanges. This split of opinion between no appellate circuits led to the Supreme Court deciding to grant certioral "Statutory Provisions Referred to in and the tax credits. So it Wands to reason E with a Federal Exchange, and key create the Conpesas meant for those provisions to wply in every Sate as well. Serta of the opinion is omitted.) D Chapter Health Reform, Access to Care, non isch compatible with the rest of the law.Chinge 1988 Supreme Court decision. Here, the ALTA. dating without the federal sub Act tells the secretary to estabish and oper foryscheme compels us to reject petition the changes would not operate as Congressitended and may not operate to the role of the legislature, and take care not congue the guaranteed issue and com mingguirements applicable in every State in the Nation. But those requirements only work we combined with the coverage que Outrole is more confined to say what the 5. Marbury v. Madison, 1 Cranch 137. 96 The Law at Healthcare Administration 97 established under section 18. if we 1776). That is used in some as than import that definition into Section of the In . in ate such American Health Benefit Exchange Interpretation because it would des to do what it has done. Ata angol established under section soi. That sus the individual insurance market in any Sue Wisation demands a fait understanding of gests that Section 18041 authorizes the Sec the legislatheplan retary to establish an Exchange under Sec very death spirals that Congress desire Congress passed the Affordable Care tion 10, not for not only) oder Section the Act to avoid. See New York State Dept. of to improve health Insurance marks, 18041. Otherwise, the Federal Exchange, by Social Servs Dublin 43 U.S. 405,419-470 to destroy them. It will possible must definition, would not be an "Exchange" at all (973) We cannot interpret federal stades Interpret the Act in a way that is consistent This interpretation of under 42 U.S.C negate their own stated purposes. with the former, and evidstheater Section 51Bosat fits best with the statutory context As discussed earlier, Congress based the 36B can fairly be read consistent with what All of the requirements that an Exchange must Affordable Care Act on three major ons wees Congress's plan, and that is the meet are in Section 1, so it is sensible to first, the guaranteed issue and community Pioners arguments about the plain mean reading wedol regard all Exchanges as established under that ing requirements, second, a requirement that The judgment of the United States Court provision. In addition, every time the Actuses Individuals maintain health insurance cover of Section 615 are strong. But while the of Appeals for the fourth Circultis meaning of the phrase "an Exchange estab- the word "Exchange the definitional prove ape or make a payment to the IRS, and the Ished by the State under 42 U.S.C. Silloir Affirmed sion requires that we substitute the phrase the tax credits for individuals with household may seem plain when viewed in isolation, "Exchange established under section Bogi." Incomes between 100 per cent and 400 per cha reading turns out to be "untenable JUSTICE SCALIA, with whom JUSTICE if Federal Exchanges were not established cent of the federal poverty line, in a state that light of the statute as a whole. In this THOMAS and JUSTICE ALITO, dissenting under Section 1, therefore, literally none establishes its own Exchange these three Instance, the content and structure of the The Court holds that when the patient of the Act's requirements would apply to them. reforms work together to expand insurance Acompels to depart from what would Protection and Affordable Care Ac says May the Act repeatedly uses the phrase coverage. The guaranteed issue and com otherwise be the most natural reading of the "Exchange established by the Star established under U.S.C. Silloin situ. nity rating requirements ensure that anyone pertinent statutory phrase means Exchange established by the State ations where it would make no sense to distin: can buy insurance the coverage require Belunce on content and structure in statu or the Federal Government. That is of course guish between State and federal Exchanges. A ment creates an incentive for people to do w tory interpretation is a subtle business, call quite absurd, and the Court's 21 pages of Federal Exchange may therefore be considered before they get sick and the tax credits - ing to treat warness test what professes explanation make it no lesso, one established under U.S.C.518" is hoped - male insurance more affordable to bene rendering becomes creation and ... This case requires us to decide ... The Affordable Care Act contains more Together, those reforms "minimize...dverse moted interpretation of legislation becomes whether someone who bosince than a few examples of inartful drafting to selection and broaden the health insurance station itself." Palmer, Massachusetts, 308 an Exchange established by the Secretary cite just one, the Act creates the separate risk pool to include healthy individuals, which 4.5.79.83 (1939). For the reasons we have gets tax credits. You would think the answer Section 1563. See 124 Stat, 270, 911, 912.) will lower health insurance premiums, twin, howeve such reliance is appropriate in would be obvious - obvious there would Anyway, we must do our best, bearing Under petitioners' readings, however, the Biscase, and leads us to conclude that Section hardly be a need for the Supreme Court to in mind the fundamental canon of statutory Act would operate quite differently in a State allows tax credits for insurance purchased construction that the words of a statute must with a Federal Exchange. As they see lone hear a case about it. In order to receive any hany Exchange created under the Act. Those money under 536, an individual must enoll be read in their context and with a view to of the Act's three major reforms -- the tar their place in the overall statutory scheme." Se are necessary for the Federal Exchanges in an insurance plan through an "achang credits -- would not apply. And a second major established by the State. The Secretary of reform--the coverage requirement --would not Date and to avoid the type of calamitous result Health and Human Services is not a State # that Congress plainly meant to wold apply in a meaningful way.... The combina Given that the text is ambiguous, we must tum So an Exchange established by the Secre tion of no tax credits and an ineffective cover tary is not an Exchange established by the to the broader structure of the Act to determine age requirement could well push a states indi: the meaning of Section 368. "A provision that vidual insurance market into a death spiral may seem ambiguous in isolation is often clari In a democracy, the power to make the Exchange fied by the remainder of the statutory scheme It is implausible that Congress meant the Act low tests with those chosen by the people. to operate in this manner. See National Feder- ... because only one of the permissible mean tion of Independent Business w. Sebelus. 567 U Ines produces a substantive effect that is 5. (2012) (SCALIA, KENNEDY, THOMAS, and State-which means people who buy health Insurance through such money under 5568 Words no longer have meaning it an Exchange that is not established by a State 5. What is the current status of Medicaid expansion in your state and nationwide? and discharge 99 funds associated with the Medicaid expan- of the law, the Court today has turned its ation to a third. The Act that Congress passed makes tax on The Court decision rellects the philoso sed by a thet ply that should endure whatever seperti distortions it takes in order to perele af the path that philosophy hores the mallin restored as posed few in the statutory Powers" enumerated in the whale og Corsress thinks that the present design of the son. Having transformed two major parts States to set up their own Exchanges. And it Act works well enough, it could do nothing Congress could also do something else to the entirely abandoning the structure of the Affordable Care Act. The Court's insistence Exchange established by the State. This oaking a choice that should be made by Congress both agandues judicial power and would prevent the rest of the Act from work Court Attend Arican people's decision to give congress 4. What effect has the ACA had on the percentage of the population without health Insurance since the individual and employer mandates began to take effect 2014 Comitation. At. Lt. They made Congress, Court, responsible for both making w and mending them. This court holds only the judicial power--the power to pro the law as Conpress has enacted it, we lack the prerogative to repair laws that do Not work out in practice, just as the people tack the ability to throw us out of office if as they dislike the solutions we concoct. We the must always remember, therefore, that "Tour task is to apply the text, not to improve upon LlQuoting a 1989 case... alice as belo show It is not our place to judge the quality met de petition is met heard of who of the care and deliberation that went into what dan change this or any other law. A low enacted by voice sted by the Seas Exchange vote with no deliberation whatever is fully as State the feel binding upon us as one enacted after years of study, months of committee hearings, and weeks of debate. Much less is it our place to and with Wining cortimation make everything come out right when Con- het 'Exchaelished by the State press does not do its job properly. It is up to what toomes, the Court Congress to design its laws with care, and it weater ble met scor interpretation is up to the people to hold them to account ir they fail to carry out that responsibility the conclusion that cogni Rather than rewriting the law under the pretense of interpreting it, the Court should by the have left it to Congress to decide what to do Je pages the precious state changes of Congress values above about the Act's limitation of tax credits to and citie Select the and ches everything else the Act's applicability across oldesde cering.coba category ble in every Exchange, Ifit prizes state the country, it could make tax credits avail Involvement in the Act's implementation, it furabile Ae win that the majority's bopic gate the economic consequences predicted by could continue to limit tax credits to state Bachanges while taking other steps to mit- the Court. I Congress wants to accommodate both goals, it could make tax credits available everywhere while offering new incentives for Court, however, concludes that this limitation encourages congressional lassitude. ing as well as hoped. So it rewrites the law Today's opinion changes the usual to make this will everywhere. We rules of statutory interpretation for the sake should start calling this law SCOTUScare of the Affordable Care Act. That, alas, is not Perhaps the best Protection and novelty. In National Federation of Inde. Affordable Care Act was the during pendent Business V. Sebellus, 567 U.S. status of the Social Security Act of the Toft- this Court revised major components of the Hartley Act perhaps not. But this Court's statute in order to save them from unconsti- Two decisions on the Act will surely be butionality. The Act that Congress passed pro remembered through the years. The somer vides that every individual "Shall maintain saults of statutory Interpretation they have Insurance or else pay a "penalty." This Court, performed (penalty means tax,"further however saw that the Commerce Clause Medicald payments to the State means does not authorize a federal mandate to buy only incremental Medicaid payments to the health insurance. So it rewrote the mandate: State, "established by the State means not cum-penalty as a tax established by the State) will be cited by The Act that Congress passed also litigants endiessly, to the confusion of honest requires every State to accept an expansion Jurisprudence. And the cases will publish for of its Medicald program, or else risk losing all ever the discouraging truth that the Supreme Medicaid funding. This Court, however, saw Court of the United States favors some lans that the Spending Clause does not autho over others, and is prepared to do whatever it rize this coercive condition. So it rewrote takes to uphold and assist its favorites the law to withhold only the incremental I dissent. Discussion Questions 1. In his recent book. The Court and the World: American Low and the New Global Realities (2015). Justice Stephen Breyer writes, "Ordinarily, when decling difficult textual questions, courts look to text, history, tradition, precedent purpose, and consequences. *** in your opinion, which opinion the majority or that of the dissest- addresses those factors more satisfactorily? 3. Can you explain the logic behind the chief justice's holding and is it persuasive to you! 3. What are the death spirals" he refers to? of the app ice" and gesit inte of the inde from the age of and he omalee concludes with elowing er