By now it is old news that the U.S. Supreme Court ruled in favor of the Obama Administration in the King v. Burwell case. At issue was the lawfulness of federal tax subsidies for individuals enrolled in federal, rather than state, health insurance exchanges. The 6-3 decision was authored by Chief Justice John Roberts. Justices Kennedy, Ginsburg, Breyer, Sotomayor, and Kagan joined Roberts in upholding the subsidies; Justices Scalia, Thomas and Alito dissented.
In the majority opinion, the Court found that the phrase “an Exchange established by the State under [42 U. S. C. §18031],” is properly viewed as ambiguous, and therefore it was incumbent upon the court to view this phrase in the context of the overall statute. Justice Roberts noted that the Court must bear in mind the “fundamental canon of statutory construction that the words of a statute must be read in their context and with a view to their place in the overall statutory scheme.”
Justice Scalia, issued a scathing dissent, asserting that we should start calling this law “SCOTUSCare” since in his view, the Court has essentially rewritten the Affordable Care Act (ACA) through this decision and the previous case — National Federation of Independent Business v. Sebelius (which upheld the individual mandate to buy insurance and allowed states to refrain from expanding coverage under Medicaid). Scalia minced no words in his dissenting opinion, charging the majority with advancing “feeble” arguments that amount to “pure applesauce” and engaging in “interpretive jiggery-pokery.”
Despite the resolution of the insurance subsidy issue, Congress must now take action to address the many broken promises of health reform, including:
- Healthcare costs continue to rise, and notwithstanding President Obama’s assurances, consumers continue to face double-digit premium increases and unaffordable deductibles.
- Despite covering more individuals, the number of uninsured remains high, and approximately 30 million Americans still lack insurance coverage.
- The majority of insurance coverage comes from enrolling individuals into Medicaid, which has well-documented access to care problems.
- Millions of consumers lost the health plan that they liked, and their choice of healthcare plans and providers have been significantly curtailed.
The AANS and CNS have called on Congress take the following steps to improve the ACA:
- Increase consumer choice beyond the current government mandated plans, by allowing individuals to choose plans such as health savings accounts.
- Eliminate burdensome regulations due to mandates like the electronic health record (EHR) meaningful use program, Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier — which only seek to further penalize healthcare providers without leading to improved quality of care.
- Ensure access to care for our Nation’s seniors by repealing the Independent Payment Advisory Board (IPAB).
- Preserve medical innovation by eliminating the medical device tax.
- Expand Medicare support for graduate medical education (GME) to ensure an appropriate supply of well‐educated and trained are available to provide access to quality healthcare services for all Americans.
As we have from the beginning of the healthcare reform debate, America’s neurosurgeons stand ready to work with policymakers to improve our healthcare system.