Considering King v. Burwell’s Construction, Interpretation
By - The aftermath of King v. Burwell is spreading like wildfire across the healthcare industry. Opinions and reactions circulate rather heavily this week – including thoughts from Sylvia M. Burwell, Secretary of the Department of Health and Human Services (HHS) – following the Supreme Court’s recent 6-3 decision in what is considered an imperatively critical healthcare ruling to uphold a key provision of the Affordable Care Act (ACA).
Susan Feigin Harris, Esquire, Healthcare Partner at Baker & Hostetler, LLP, spoke with RevCycleIntelligence.com immediately following yesterday’s King v. Burwell decision from the Supreme Court to offer a closer examination and breakdown of recent events.
Earlier this week, Feigin Harris told RevCycleIntelligence.com the healthcare community is indeed in dire need of certainty; she then referred to a King verdict as the beginning of a “downward death spiral.” She confirms support for yesterday’s Supreme Court decision and is hopeful the healthcare industry can now effectively focus its efforts onwards to solve additional problems of costs, access, and efficiencies.
“The Dissent, while immensely fun to read, draws the clear lines in statutory interpretation between a strict construction of language and the use of context in how we interpret our laws,” Feigin Harris states. “While the law, as written, ‘does not reflect the type of care and deliberation that one might expect of such significant legislation,’ there was a recognition by the majority of the Court that such is the dance of legislation which leads to the need to refine and interpret laws,” she says.
“The written opinion is more interesting in that the Court determined, unlike in the earlier circuit court, that Congress did not delegate to the administrative agency, the Internal Revenue Service (IRS), any authority, and, therefore, no Chevron deference (a key administrative law application requiring a two-step analysis that was used in the 4th circuit case) is required to be applied,” confirms Feigin Harris.
“The Court found that the use of tax credits was among the Affordable Care Act’s key reforms and therefore, whether the credits are available on a state or federal exchange is a question of ‘deep economic and political significance’ central to the statutory scheme. As such, the context of how the exchanges were completed in the statute was of paramount significance,” she states.
According to Feigin Harris, the Supreme Court found through lengthy analysis that the use of the term “exchange” had a dual meaning – referring to either state or federal. Both meanings were indeed equivalent within the law’s written context, she says.
“The Court also relied upon the core goal of the Affordable Care Act itself to ensure guarantee issue and community ratings were applicable in every State in the Nation. Since these requirements only work in tandem with the coverage requirements in the law, ‘Congress must have meant for those provisions to apply in every state as well,’” maintains Feigin Harris.
“The Court recognized its role ‘not to undo what it [Legislature] has done. A fair reading of legislation demands a fair understanding of the legislative plan.’ Thus, in the end, the context of how a statute comes together, the context of what the legislature intended, and the legislative history of a statute won the day,” she states.
