On Thursday, the Supreme Court rejected a second challenge to President Barack Obama's signature health care law, holding that the federal government can set up subsidized exchanges in states that failed to create their own.
The 6-3 ruling in King v. Burwell put to bed the latest, and likely final, major challenge to the Affordable Care Act. Much like the last time around, conservative Chief Justice John Roberts took the pen himself to save a law many conservatives hoped he would kill once and for all.
For Roberts, the ruling cements his legacy as the chief who ensured that the ACA would become an established part of the American fabric and a legally bulletproof pillar of the social safety net. His willingness to buck political expectations and shepherd a raucous and divisive issue through the halls of the Supreme Court in a way few expected demonstrates a profound respect for the integrity of both his institution and the legislative process.
The case: The central argument of the case hinged on whether ACA language that enabled individuals enrolled in exchanges "established by the state" to get subsidies limited those subsidies to individuals enrolled in exchanges established exclusively by the individual states rather than the federal government.
Opponents of the law contended that the language clearly limited subsidies to exchanges set up by individual states. The government argued that this was little more than a clerical oversight and that subsidy rules applied to any exchanges created under the ACA.
Roberts, Justice Anthony Kennedy and the court's four liberal justices agreed, with Roberts writing that the court's duty was to "construe statutes, not isolated provisions" and that words must be read in context.
The ruling saves federal subsidies for more than 6 million people and sustains the newly created insurance market built to support federal and state exchanges. Echoing arguments made by Solicitor General Donald Verrilli before the court in March, Roberts pointed out that reading the law to prohibit federal subsidies "would destabilize the individual insurance market in any state with a federal exchange, and likely create the very 'death spirals' that Congress designed the act to avoid," noting that it was "implausible that Congress meant the act to operate in this manner."
What it means: In the years and decades to come, few outside the legal profession will ever revisit this opinion, in much the same way that we no longer read the challenges to Social Security. With this ruling, Roberts and his court have settled the issue for the American people, and hindsight will eventually show that the challenges and arguments in King v. Burwell were so unremarkable as to not even be worthy of mention.
In his conclusion, Roberts noted that "Congress passed the ACA to improve health insurance markets, not destroy them," and that it was the court's responsibility to interpret the ACA in a way "that is consistent with the former, and avoids the latter." For the second time in three years, Roberts did just that.