Conflicting Opinions: Health care law may head back to the Supreme Court

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On June 28, 2012, the Supreme Court narrowly upheld President Barack Obama’s landmark, but controversial, legislation: the Affordable Care Act, popularly known as Obamacare.

The decision seemingly put a loud and angry debate between conservative republicans and democrats to rest. But on Tuesday, the contentious legislation meant to extend affordable health care to millions of Americans, again raised its head after two appeal courts issued conflicting rulings on whether the Obama administration wrongly extended financial assistance to people who bought insurance via healthcare.gov.

The U.S. Court of Appeals for the District of Columbia Circuit issued a 2-1 ruling that federal subsidies granted to people in states (including Texas) that haven’t set up health care exchanges should not have been released. You can read the ruling here.

And when you strip this health care debate down to its bare bones, the diagnosis is clear: it’s all about semantics.

Within the ACA, there is language that states the Internal Revenue Service may issue subsidies to people who apply for insurance through state exchanges. The language doesn’t include the word “federal.” In another part of the ACA, the wording states that the federal government may run exchanges in states that do not set up exchanges.

Words have meaning and that matters, but thus far, Democratic leaders have stressed overall intent – providing affordable health care to millions of Americans – trumps the actual language of the legislation, which the U.S. Court of Appeals for the Fourth Circuit (based in Richmond, Va.) unanimously upheld. You can read that ruling here.

But the U.S. Court of Appeals for the District of Columbia Circuit ruled that the actual language outweighs the intent.

“We reach this conclusion, frankly, with reluctance. At least until states that wish to or can set up Exchanges, our ruling will likely have significant consequences both for the millions of individuals receiving tax credits through federal Exchanges and for health insurance markets more broadly,” Circuit Judge Thomas B. Griffith wrote in the majority opinion. “But, high as those stakes are, the principle of legislative supremacy that guides us is higher still. Within constitutional limits, Congress is supreme in matters of policy, and the consequence of that supremacy is that our duty when interpreting a statute is to ascertain the meaning of the words of the statute duly enacted through the formal legislative process.”

According to the Department of Health and Human Services, 733,757 Texans signed up for health care through a federal exchange (Texas won’t set up a state exchange), many of whom probably applied for federal financial assistance.

And while the D.C. appeals court ruled one way, the United States Court of Appeals for the Fourth Circuit landed on the other side of the aisle.

“The majority opinion understandably engages with the Appellants and respectfully posits they could be perceived to advance a plausible construction of the Act, i.e., that Congress may have sought to restrict the scope of the contingency provision when it used the phrase ‘established by the State’ in the premium tax credits calculation subprovision,” Circuit Judge Roger Gregory wrote. “But as the majority opinion deftly illustrates, a straightforward reading of the Act strips away any and all possible explanations for why Congress would have intended to exclude consumers who purchase health insurance coverage on federally-run Exchanges from qualifying for premium tax credits.”

And the ruling doesn’t mince words.

“The best Appellants can come up with seems to be some non-existent Congressional desire for ‘state leadership’ (whatever that means) in effecting a comprehensive overhaul of the nation’s health insurance marketplaces and related health care markets,” Gregory wrote.

The ruling goes on to call the “literal reading” nonsensical.

With both rulings, however, it looks like Obamacare may head back to the Supreme Court.

But before it does, expect to hear a copious amount of rhetoric from politicians who are for or against the ACA. Let's take a look at what a few initial reactions to the ruling:

"Another partisan attempt to harm the Affordable Care Act failed today.  This latest attempt was undermined by a unanimous judicial panel in the 4th Circuit. The law was designed to make health care affordable through tax credits – and it is working," the White House said in a statement.

State Sen. Ted Cruz, who was elected on an anti-ACA platform, said the D.C. Circuit ruling is a repudiation of "lawlessness" caused by the health care law.

"The Obama Administration, through the Internal Revenue Service, has attempted to dispense revenues to the states without proper congressional authorization, robbing Congress of its constitutionally-provided power of the purse," Cruz said in a statement, the rest of which can be read here.

Democratic Leader Nancy Pelosi chimed in on the 4th Circuit ruling and also slammed the opposition.

“The American people deserve better than Republicans’ lawsuits and legislative nihilism.  We are confident that as these cases advance, the plaintiffs’ obviously false interpretation of the law will be exposed as the baseless and desperate Republican distraction that it is," Pelosi said in a statement, the rest of which can be read here.

And we can go on and on because we all know that if there is one thing politicians are good at, it's talking smack about the opposition.

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