Supreme Court Justice Sonia Sotomayor may have just saved the Affordable Care Act (ACA).
The case involves federal subsidies to lower-income individuals to help pay for health insurance on each state’s “exchange.” The question is whether subsidies can go only to individuals in states that set up state exchanges or also to individuals in states with federal exchanges. The subsidies have been provided in all states, no matter who runs the exchange. A decision for the opponents would cause the loss of affordable health coverage by millions of Americans in states with federal exchanges.
ACA opponents argue that it is fair to subsidize only states that set up their exchanges—conveniently ignoring the fact that all states received federal funds for their exchanges.
However, Justice Sotomayor asked whether this interpretation violates the principle of federalism and the Court’s long-held position that federal coercion of states is unconstitutional. Sotomayor suggested that paying subsidies only in state exchanges would be unconstitutional coercion, forcing states to create exchanges.
Justice Sotomayor mentioned another previous case in which Chief Justice Roberts and Justice Kennedy wrote the opinions. Roberts and Kennedy happen to be considered “swing” votes in this case.
Roberts and Kennedy followed Sotomayor’s line of questioning , agreeing that ACA opponents’ argument would force a vote to preserve the ACA in order to avoid unconstitutional federal coercion. The final decision comes this spring, but the consensus among experts is that the case is finished, and the ACA and its subsidies will survive.