In a sane world every state that did not set up an exchange would have supported the Burwell decision and would have said that there was no need for Supreme Court review. After all, these States did not have to spend money to set up an exchange. And if subsidies are not available to their citizens through the Federal Exchange many of those folks will not be able to afford insurance. Also, unlike the issue of Medicaid expansion, this issue does not involve the expenditure of State funds. The States do not pay a cent towards these subsidies.
But it is not a sane world, which is why Ok, AL, Ga, IN, NE, SC and WV filed a petition together asking the Supreme Court to review the Burwell decision and strongly hinting it should be overturned. Their stated reason was that the matter needed to be settled so that they would know whether they needed to set up exchanges. But both their words and the tenor of their petition was that they hope that the Court will effectively neuter the ACA in a large part of the country. This is Obama derangement syndrome at its worst.
It is interesting that the Court agreed to take the Burwell even though there is no split among the Circuits on the issue. There had been an earlier conflicting decision in the DC Circuit but that decision was set aside when the full DC Circuit decided to rehear the case. Many observers worry that this does not bode well for the ACA. But the optimist in me hopes that Justice Roberts, who already passed on a chance to kill the ACA when he uphold the individual mandate, is not going to turn around and neuter it by striking down the subsidies. After all, the mandate made people do something but here you are just giving them money and helping them afford insurance. I also hope Kennedy upholds the subsidies as a way to finally get on the right side of the ACA.
As to the merits of the argument against subsidies in the Federal exchange, the Solicitor Generals brief eviscerates the challengers arguments.
The challengers sole argument is that one section of the law that refers to subsidies says that they are available on "an Exchange established by a State" and therefore subsidies are unavailable if the Federal Government sets up an exchange for a State. The DOJ points out that there are numerous other provisions of the law that make clear that for any state that elects not to establish an exchange that Federal Government can establish one in its stead and for all purpose of the law that too is "an exchange established by a State." Here is the summary from DOJ's brief,
The Act provides that each State “shall * * * establish an American Health Benefits Exchange.” 42 U.S.C. 18031(b)(1). But, in a provision expressly designed to respect the sovereign dignity of each State by affording “State flexibility,” 42 U.S.C. 18041, the Act provides two ways for that requirement to be satisfied. First, a State may elect to create the Exchange on its own. 42 U.S.C. 18041(b). Alternatively, if a State does not elect to establish the “required Exchange” itself, then HHS will “establish and operate such Exchange within the State.” 42 U.S.C. 18041(c)(1). Either choice satisfies Section 18031(b)(1)’s requirement that each State “shall * * * establish an [Exchange].” The text of the Act thus makes clear that an Exchange established by HHS in a State’s stead is, as a matter of law, “an Ex- change established by the State.”
That interpretation harmonizes the Act’s text, structure, and purpose. Petitioners’ reading, in contrast, would transform the Act into a hash of superfluities, absurdities, and internal contradictions. It would obstruct the Act’s express purpose by denying affordable insurance to millions of Americans. It would thwart the operation of the Act’s interdepend- ent reforms and gut the Exchanges through which those reforms are implemented. And it would destroy the Act’s model of cooperative federalism by trans- forming the Act’s promise of “State flexibility” into a threat that a State may forgo establishing an Ex- change for itself only at the price of crippling its insurance market and depriving its citizens of the tax credits at the heart of the Act. The Act unambiguously forecloses that construction. At a minimum, the IRS’s interpretation is a permissible one meriting deference under Chevron.
The brief goes on to explain these arguments in detail. It is well worth the reading.
But we are left with this. There are States that are led by people who hate the President so much that they will go to any lengths, conjure up any bogus arguments,and pursue any course to attack the President and his Presidency even if it directly harms the lives, health and financial security of their own citizens.