Addresses whether tax credits mandated under the ACA apply in states that did not establish an ACA health insurance marketplace—an "American Health Benefit Exchange."
The Affordable Care Act had three main components. First, it required that insurance providers give health insurance to anyone who applied for it, and barred the practice of charging higher premiums based on existing health conditions. Second, it required that all individuals either purchase health insurance or pay a fee to the IRS (an exemption exists for those who would have to spend more than 8 percent of their income on health insurance). Third, it introduced a system of tax credits to those who purchased a plan, to make the cost more bearable. This last point was critical, as the tax credits bring the price of health insurance below 8 percent of income for millions of people. The bill mandated the establishment of an "American Health Benefit Exchange" in each state. Each state government chooses whether to operate the marketplace itself, or have the Secretary of Health of Human Services establish and operate it. At question in this case was whether the tax credits mentioned above apply in states who elected to have the federal government establish an insurance marketplace. The Supreme Court ruled that the tax credit rules apply equally in the exchanges set up by state governments and in those set up by the federal government. In the majority opinion (1), Justice Roberts writes that "[...] State and Federal exchanges would differ in a fundamental way if tax credits were available only on State exchanges--one type of exchange would help make insurance mroe affordable by providing billions of dollars to the States' citizens; the other type of Exchange would not." (Section A, p. 13) The tax credits are "necessary for the Federal Exchanges to function like their State Exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid." (Section D, pg. 21)
1. King v. Burwell, Majority Opinion