US Supreme Court’s exoneration of the Affordable Care Act

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3507 (Published 26 June 2015) Cite this as: BMJ 2015;350:h3507
  1. Robert Steinbrook, professor adjunct
  1. 1Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
  1. robert.steinbrook{at}yale.edu

Survives second major constitutional challenge and may finally be here to stay

Having survived its second major US Supreme Court challenge in three years, the Affordable Care Act, popularly known as “Obamacare,” is very likely to remain in effect after President Barack Obama leaves office in 2017 and may yet become a lasting and important part of the social safety net in the United States, like Medicare and Social Security.

In a 6-3 decision issued on 25 June 2015, the Supreme Court ruled constitutional the federal government’s ability to subsidize eligible people on lower and middle incomes to buy health insurance on the federal marketplace.1 Writing for the majority, Chief Justice John Roberts bluntly stated: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.” Abolishing the subsidies on the federal health insurance exchanges, which would have the effect of decreasing the number of people with health insurance, “could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner.”1

The Supreme Court rejected the first constitutional challenge to the Patient Protection and Affordable …

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