Jacqueline Halbig v. Sylvia Mathews BurwellJacqueline Halbig v. Sylvia Mathews Burwell
Lead Opinion
Opinion for the Court filed by Circuit Judge GRIFFITH.
Concurring opinion filed by Senior Circuit Judge RANDOLPH.
Dissenting opinion filed by Senior Circuit Judge EDWARDS.
Sеction 36B of the Internal Revenue Code, enacted as part of the Patient Protection and Affordable Care Act (ACA or the Act), makes tax credits available as a form of subsidy to individuals who purchase health insurance through marketplaces — known as “American Health Benefit Exchanges,” or “Exchanges” for short — that are “established by the State under section 1311” of the Act.
Appellants are a group of individuals and employers residing in states that did not establish Exchanges. For reasons we explain more fully below, the IRS’s interpretation of
On cross-motions for summary judgment, the district court rejected that challenge, granting the government’s motion and denying appéllants’. See Halbig v. Sebelius, No. 13 Civ. 623(PLF), — F.Supp.3d -,
' Appellants timely appealed the district court’s orders, and we have jurisdiction under
I
Congress enacted the Patient Protection and Affordable Care Act in 2010 “to increase the number of Americans covered by health insurance and decrease the cost of health care.” Nat’l Fed’n of Indep. Bus. v. Sebelius (NFIB), — U.S. -,
Under
But, in a regulation promulgated on May 23, 2012, the IRS interpreted
This broader interpretation has major ramifications. By making credits more widely available, the IRS Rule gives the individual and employer mandates' — key provisions of the ACA — broader effect than they would have if credits were limited to state-established Exchanges. The individual mandate requires individuals to maintain “minimum essential coverage” and, in general, enforces that requirement with a penalty. See
The IRS Rule affects the employer mandate in a similar way. Like the individual mandate, the employer mandate uses the threat of penalties to induce large employers — defined as those with at least 50 employees, see
Before we can turn to the merits of the parties’ dispute, we must first address the government’s argument that all appellants lack standing and that, even if they have standing, the APA does not provide them with a cause of action to challenge the IRS Rule. Because we find that appellant David Klemencic has standing and a cause of action under the APA, we do not reach the issue of our jurisdiction over the remaining appellants’ claims. See Mountain States Legal Found. v. Glickman,
A
The “ ‘irreducible constitutional minimum’ ” a plaintiff must show to establish standing is (1) an injury in fact (2) fairly traceable to the alleged conduct of the defendant (3) that is likely to be redressed by the relief the plaintiff seeks. Sprint Commc’ns Co. v. APCC Servs., Inc.,
The government primarily questions whether Klemencic has suffered an injury in fact. An injury in fact is “a concrete and particularized invasion of a legally protected interest.” Sprint Commc’ns Co.,
B
The APA provides a cause of action to challenge final agency action “for which there is no other adequate remedy in a court.”
The APA “embodies the basic presumption of judicial review” of agency action. Abbott Labs. v. Gardner,
In arguing that a tax refund suit provides an adequate alternative remedy, the government emphasizes Klemencic’s ability to recover any assessed overpayment, plus interest. But that backward-looking relief differs in kind from the prospective relief Klemencic could obtain under the APA. See Bowen,
Furthermore, it is not clear that Klem-encic could obtain any prospective relief through a refund action, let alone that which he seeks under his APA claim— namely, a declaration that the IRS Rule is invalid and an injunction barring its implementation. As we explained in Cohen v. United States, the provision authorizing refund suits “does not, at least explicitly, allow for prospective relief.”
Ill
On the merits, this easе requires us to determine whether the ACA permits the IRS to provide tax credits for insurance purchased through federal Exchanges. To make this determination, we begin by asking “whether Congress has directly spoken to the precise question at issue,” for if it has, we must give effect to its unambiguously expressed intent. Chevron U.S.A., Inc. v. Natural Res. Def. Council,
Although both appellants and the government argue that the ACA, read in its totality, evinces clear congressional intent, they dispute what that intent actually is. Appellants argue that if taxpayers can receive credits only for plans enrolled in “through an Exchange established by the State under section 1311 of the [ACA],” then the IRS clearly cannot give credits to taxpayers who purchased insurance on an Exchange established by the federal government. After all, the federal government is not a “State,” see
We conclude that appellants have the better of the argument: a federal Exchange is not an “Exchange established by the State,” and
A
The crux of this case is whether an Exchange established by the federal government is an “Exchange established by the State under section 1311 of the [ACA].” We therefore begin with the provisions authorizing states and the federal government to establish Exchanges. Section 1311 provides that states “shall” establish Exchanges.
The phrase “such Exchange” has twofold significance. First, the word “such”— meaning “aforementioned,” see Black’s Law Dictionary 1473 (8th ed.2004); Webster’s Third Int’l Dictionary 2283 (1981)— signifies that the Exchange the Secretary must establish is the “required Exchange” that the state failed to establish. In other words, “such” conveys what a federal Exchange is: the equivalent of the Exchange a state would have established had it elected to do so. The meaning of “Exchange” in the ACA reinforces and builds on this sense. The ACA defines an “Exchange” as “an American Health Benefit Exchange established under [section 1311 of the ACA].”
The problem confronting the IRS Rule is that subsidies also turn on a third attribute of Exchanges: who established them. Under
The dissent attempts to supply this missing equivalency by pointing to section 1311(d)(1), which provides: “An Exchange shall be a governmental agency or nonprofit entity that is established by a State.”
The premise that (d)(1) is definitional, however, does not survive examination of (d)(l)’s context and the ACA’s structure. The other provisions of section 1311(d) are operational requirements, setting forth what Exchanges must (or, in some cases, may) do.
The dissent’s reading would also require us to overlook the fact that section 1311(d) would be a strange place for Congress to have buried such a legal fiction. Section 1311, after all, concerns Exchanges that are established by states in fact; the legal fiction the dissent urges would matter only to Exchanges established by the federal government. To accept the dissent’s construction would therefore transform (d)(1) into the proverbial elephant in the mouse-hole — the “ancillary provision! ]” that “alter[s] the fundamental details of a regulatory scheme.” Whitman v. Am. Trucking Ass’ns,
The dissent’s construction of (d)(1) also ignores the structural relationship between sections 1311 and 1321. Just as section 1311(b)(1) assumes that states will establish Exchanges in general, see
Instead, sections 1311 and 1321 lead us to interpret
B
The government argues that we should not adopt the plain meaning of
i
The government first argues that we must uphold the IRS Rule to avoid rendering language in
(A) The level of coverage ... and the period such coverage was in effect.
(B) The total premium for the coverage without regard to the credit under this section or cost-sharing reductions under section 1402 of [the ACA],
(C) The aggregate amount of any advance payment of such credit or reductions ....
(D) The name, address, and [taxpayer identification number (TIN) ] of the primary insured and the name and TIN of each other individual obtaining coverage under thе policy.
(E) Any information provided to the Exchange, including any change of circumstances, necessary to determine eligibility for, and the amount of, such credit.
(F) Information necessary to determine whether a taxpayer has received excess advance payments.
Not so. Even if credits are unavailable on federal Exchanges, reporting by those Exchanges still serves the purpose of enforcing the individual mandate — a point the IRS, in fact, acknowledged in promulgating a recent regulation,
Furthermore, holding that credits are unavailable on federal Exchanges would not convert the specific reporting requirements concerning credits into an “ ‘empty gesture.’ ” Gov’t Br. 28 (quoting Fund for Animals, Inc. v. Kempthorne,
ii
The government next points to the supposedly absurd consequences appellants’ interpretation of
The government, however, tilts at windmills. It assumes that when section 1312(a) states that “[a] qualified individual may enroll in any qualified health plan available to such individual and for which such individual is eligible,”
Several other provisions in section 1312 imply that not only “qualified individuals” may participatе in an Exchange. Take, for example, the provision concerning incarcerated convicts. Section 1312(f)(1)(B) states that “[a]n individual shall not be treated as a qualified individual if, at the time of enrollment, the individual is incarcerated, other than incarceration pending the disposition of charges.”
iii
The government also claims that a plain meaning reading of
iv
The government urges us, in effect, to strike from
C
This conclusion places us at a fork in our precedent. One line of cases instructs us to cease our inquiry and give effect to the statute’s unambiguous language. See Coal. for Responsible Regulation, Inc. v. EPA
We begin by clarifying the role the ACA’s legislative history might play in our analysis. Legislative history is a means to an end, to be consulted for evidence of congressional intent. See, e.g., Sierra Club,
Here, the scant legislative history sheds little light on the precise question of the availability of subsidies on federal Exchanges. The government points, for example, to a Congressional Budget Office report from November 2009, before the ACA’s adoption, that calculated the cost of subsidies based on the assumption that they would be available in all states. But that assumption is as consistent with an expectation that all states would cooperate (i.e., establish their own Exchanges) as
The government and its amici are thus left to urge the court to infer meaning from silence, arguing that “during the debates over the ACA, no one suggested, let alone explicitly stated, that a State’s citizens would lose access to the tax credits if the State failed to establish its own Exchange.” Br. of Amici Members of Congress and State Legislatures 8. The historical record, however, belies this claim. The Senate Committee on Health, Education, Labor, and Pensions (HELP) proposed a bill that specifically contemplated penalizing states that refused to participate in establishing “American Health Benefit Gateways,” the equivalent of Exchanges, by denying credits to such states’ residents for four years. See Affordable Health Choices Act, S. 1679, 111th Cong. § 3104(a), (d)(2) (2009). This is not to say that
In any case, even if the historical record were silent, that silence is unhelpful to the government. For the court to depart from the ACA’s plain meaning, which favors appellants, “there must be evidence that Congress meant something other than what it literally said,” from which the court can conclude that applying the statute literally would be “ ‘demonstrably at odds with the intentions of [the ACA’s] drafters.’ ” Engine Mfrs. Ass’n,
The government, together with the dissent, also leans heavily on a more abstract form of legislative history — Congress’s broad purpose in passing the ACA — urging the court to view
Moreover, the territories are not the only instance where the ACA did the unimaginable. A separate title of the ACA, known as the Community Living Assistance Services and Supports (CLASS) Act, see ACA, Pub.L. No. 111-148, §§ 8001-8002, 124 Stat. 119, 828-47 (2010), required the Secretary of HHS to establish a long-term care insurance program subject to guaranteed issue and community rating requirements but unaided by an individual mandate or premium subsidies, see
The CLASS Act and the provisions applicable to the territories attest that Congress twice did exactly what the government and the dissent insist it never would: introduce significant adverse selection risk to insurance markets. This is not to say that as Congress did in the CLASS Act and territories, so too must it have done in
More generally, the ACA’s ultimate aims shed little light on the “precise question at issue,” Chevron,
The fact is that the legislative record provides little indication one way or the other of congressional intent, but the statutory text does.
IV
We reach this conclusion, frankly, with reluctance. At least until states that wish to can set up Exchanges, our ruling will likely have significant consequences both for the millions of individuals receiving tax credits through federal Exchanges and for health insurance markets more broadly. But, high as those stakes are, the principle of legislative supremacy that guides us is higher still. Within constitutional limits, Congress is supreme in matters of policy, and the consequence of that supremacy is that our duty when interpreting a statute is to ascertain the meaning of the words of the statute duly enacted through the formal legislative process. This limited role serves democratic interests by ensuring that policy is made by elected, politically accountable representatives, not by appointed, life-tenured judges.
Thus, although our decision has major consequences, our role is quite limited: deciding whether the IRS Rule is a permissible reading of the ACA. Having concluded it is not, we reverse the district court and remand with instructions to grant summary judgment to appellants and vacate the IRS Rule.
Notes
. Although West Virginia actually passed legislation authorizing the establishment of an Exchange, see W. VA. CODE § 33-16G-1 et seq., it subsequently decided to allow the federal government to establish the Exchange, in partnership with the state, due to cost concerns, see Nat’l Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Action — May 2014, http:// www.ncsl.Org/Portals/l/Documents/HeaIth/ Health_Insurance_Exchanges_State_Profiles. pdf#page=49 (last visited June 12, 2014).
. Specifically, the ACA permits territories to be treated as states for the limited purposes of sections 1311, 1312, and 1313. See
. Although we attach little weight to section titles, the title of section 1321(c) — "Failure to establish Exchange or implement requirements” — reinforces this interpretation. See Gorman v. Nat’l Transp. Safety Bd.,
. The government makes its own elephants-in-mouseholes argument, asserting that the formula for calculating tax credits (located in
Equally unpersuasive is the dissent's suggestion that
. Appellants also suggest that the information collected from federal Exchanges could be useful for the "Study on Affordable Coverage”
. The dissent takes a slightly different tack, emphasizing that the "principal purpose” of the reporting requirement is to reconcile advance and end-of-year payments. Dissenting Op. at 423-24. We agree but fail to see how this helps the government. Reporting by state-established Exchanges still would serve this purpose, while reporting by federally-established Exchanges would serve the secondary purpose implicitly recognized by
. Under the ACA, qualified health plans may offer four different levels of coverage: bronze, silver, gold, and platinum. The level of coverage reflects the percentage of the insured’s medical costs that the plan’s benefits are designed to cover. See
. The government warns that interpreting section 1312(a) as a non-discrimination provision would allow undocumented aliens to shop on Exchanges. Gov’t Br. at 31. But section 1312 specifically addresses that concern, providing that aliens not "lawfully present in the United States ... may not be covered under a qualified health plan in the individual market that is offered through an Exchange.”
.We note that section 1312’s heading, "Consumer Choice,” and subsection 1312(a)'s heading, "Choice,” also suggest that the purpose of section 1312(a) is primarily to protect choice among levels of coverage, not restrict access to Exchanges.
. In a footnote, the government identifies another set of provisions that supposedly embodies the assumption that federal Exchanges are Exchanges “established by the State”:
. Appellants do not challenge the government’s account of the economic theory behind the ACA, but they contend that the theory must be understood through the lens of political reality. In their telling,
Like the government, however, appellants fail to marshal persuasive evidence (apart from the statutory text, that is) in support of their theory. Senator Nelson may have opposed a single, national exchange, but it does not necessarily follow that he opposed making subsidies available on federal fallback Exchanges in uncooperative states. Similarly, the fact that the ACA contained some incentives to states does not necessarily mean that
. The dissent attempts to distinguish the market targeted by the CLASS Act from the individual insurance market by pointing out that the CLASS Act contains no individual mandate. In the dissent's view, the omission "of a tool [Congress] knew to be important to preventing adverse selection merely indicates that Congress had a substantially higher tolerance for the risk of adverse selection” in peripheral markets than in the core market. Dissenting Op. at 422. This argument, however, assumes the very conclusion at issue, taking for granted that the mandate in the individual market indeed is as broad as it must be to eliminate all adverse selection risk. But the plain language of
We recognize that, from an economic standpoint, such adverse selection risk bodes ill for individual insurance markets. But it made no more sense economically in the CLASS Act. Congress may simply have miscalculated the consequences of omitting a
Dissenting Opinion
dissenting:
This case is about Appellants’ not-so-veiled attempt to gut the Patient Protec
As explained below, there are three critical components to the ACA: nondiscrimination requirements applying to insurers; the “individual mandate” requiring individuals who are not covered by an employer to purchase minimum insurance coverage or to pay a tax penalty; and premium subsidies which ensure that the individual mandate will have a broad enough sweep to attract enough healthy individuals into the individual insurance markets to create stability. These components work in tandem. At the time of the ACA’s enactment, it was well understood that without the subsidies, the individual mandate was not viable as a mechanism for creating a stable insurance market.
Appellants’ proffered construction of the statute would permit States to exempt many people from the individual mandate and thereby thwart a central element of the ACA. As Appellants’ amici candidly acknowledge, if subsidies are unavailable to taxpayers in States with HHS-created Exchanges, “the structure of the ACA will crumble.” Scott Pruitt, Obama Care’s Next Legal Challenge, Wall St. J., Dec. 1, 2013. It is inconceivable that Congress intended to give States the power to cause the ACA to “crumble.”
Appellants contend that the phrase “Exchange established by the State” in
Because IRS and HHS have been delegated authority to jointly administer the ACA, this case is governed by the familiar framework of Chevron U.S.A. Inc. v. Natural Resources Defense Council, Inc.,
Apparently recognizing the weakness of a claim that rests solely on
The majority opinion ignores the obvious ambiguity in the statute and claims to rest on plain meaning where there is none to be found. In so doing, the majority misapplies the applicable standard of review, refuses to give deference to the IRS’s and HHS’s permissible constructions of the ACA, and issues a judgment that portends disastrous consequences. I therefore dissent.
I. Standard of Review
The first question a reviewing court must ask in a case of this sort is whether the disputed provisions of the statute are clear beyond dispute. “If a court, employing traditional tools of statutory construction, ascertains that Congress had an intention on the precise question at issue, that intention is the law and must be given effect.” Chevron,
[A] reviewing court should not confine itself to examining a particular statutory provision in isolation. Rather, the meaning — or ambiguity — of certain words or phrases may only become evident when placed in context.... It is a 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.
Nat’l Ass’n of Home Builders,
In other words, “[t]he plainness or ambiguity of statutory language is determined by reference to the language itself, the specific context in which that language is used, and the broader context of the statute as a whole.” Robinson v. Shell Oil Co.,
When a “court determines Congress has not directly addressed the precise question at issue, the court does not simply impose
Appellants argue that Chevron deference is unwarranted because some of the provisions at issue “are codified in a chapter of Title 42 ... the domain of HHS, not the IRS,” and the “IRS has no power to enforce or administer those provisions.” Br. for Appellants at 46. Appellants’ position is mistaken. Chevron applies because IRS and HHS are tasked with administering the provisions of the ACA in coordination. See
Appellants also argue that Chevron deference is precluded by the canon that “tax credits ‘must be expressed in clear and unambiguous terms.’ ” Br. for Appellants at 51 (quoting Yazoo & Miss. Valley R.R. Co. v. Thomas,
Chevron plainly applies to this case. And this court is obliged to defer to the IRS’s and HHS’s “permissible” interpretations of the ACA. Chevron,
II. Analysis
Appellants’ argument focuses almost entirely on
Appellants’ argument unravels, however, when the phrase “established by the State” is subject to close scrutiny in view of the surrounding provisions in the ACA. See Brown & Williamson,
Perhaps because they appreciate that no legitimate method of statutory interpretation ascribes to Congress the aim of tearing down the very thing it attempted to construct, Appellants in this litigation have invented a narrative to explain why Congress would want health insurance markets to fail in States that did not elect to create their own Exchanges. Congress, they assert, made the subsidies conditional in order to incentivize the States to create their own exchanges. This argument is disingenuous, and it is wrong. Not only is there no evidence that anyone in Congress thought
It makes little sense to think that Congress would have imposed so substantial a condition in such an oblique and circuitous manner. See Whitman v. Am. Trucking Ass’ns,
In the end, the question for this court is whether
It is not the prerogative of this court to interpret the ambiguities uncovered in the ACA. Congress has delegated this authority to the IRS and HHS. And the interpretation given by these agencies is not only permissible but also the better construction of the statute because
A. Appellants’ “Plain Meaning” Argument Viewed in Context
In arguing that the ACA clearly and unambiguously bars subsidies to individuals who purchase insurance in States in which HHS created the Exchange on the State’s behalf, Appellants rest on a narrow, out-of-context interpretation of
We cannot read
Of course, the ACA is broader than just
Indeed, the Act says as much when it defines the term “Exchange” as “a governmental agency or nonprofit entity that is established by a State.”
What is more, Appellants’ interpretation of the operative language in
The simple truth is that the phrase “established by the State” in
Furthermore, in order to address the question before us, this court is obliged to consider
B. The Statute Read as a Whole
1. The “Three-Legged Stool” and the Indispensable Role of the Tax Subsidies
Appellants’ interpretation is implausible because it would destroy the fundamental policy structure and goals of the ACA that are apparent when the statute is read as a whole. A key component to achieving the Act’s goal of “near-universal coverage” for all Americans is a series of measures to reform the individual insurance market.
This point is essential and worth explaining in detail. The ACA has been described as a “three-legged stool” in view of its three interrelated and interdependent reforms. Br. for Economic Scholars at 7. The first “leg” of the ACA is the “guaranteed issue” and “community rating” provisions, which prohibit insurers from denying coverage based on health status or history,
This is where the individual mandate, the second “leg” of the ACA, comes in. Congress recognized:
[I]f there were no requirement, many individuals would wait to purchase health insurance until they needed care. By significantly increasing health insurance coverage, the [individual coverage] requirement, together with the other provisions of this Act, will minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums. The requirement is essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.
The third “leg” of the ACA is the subsidies. The subsidies ensure that the individual mandate will have a broad enough sweep to attract enough healthy individuals into the individual insurance markets to create stability, i.e., to prevent an adverse-selection death spiral. Without the subsidies, the individual mandate is simply not viable as a mechanism for creating a stable insurance market: the lowest level of coverage for typical subsidy-eligible participants will cost 23% of income, meaning that these individuals will be exempt from the mandate. Id.; Br. for Economic Scholars at 17-18. Congress was informed of the importance of the subsidies to the overall legislative scheme. See Roundtable Discussion on Expanding Health Care Coverage: Hearing Before the
If nothing else, it is clear that premium subsidies are an essential component of the regulatory framework established by the ACA. If, as Appellants contend, a State could block subsidies by electing not to establish an Exchange, this would exempt a large number of taxpayers from the individual mandate, cause the risk pool to skew toward higher risk people, and effectively cut the heart out of the ACA. This is one of the points that was made in the joint opinion by Justice Scalia, Justice Kennedy, Justice Thomas, and Justice Ali-to in National Federation of Independent Business v. Sebelius:
Without the federal subsidies, individuals would lose the main incentive to purchase insurance inside the exchanges, and some insurers may be unwilling to offer insurance inside of exchanges. With fewer buyers and even fewer sellers, the exchanges would not operate as Congress intended and may not operate at all.
A comparison with the ACA’s Medicaid expansion condition offers a striking case in point. This condition demonstrates that Congress knew how to speak clearly and provide notice to States when it intended to condition funding on State behavior. The Medicaid provision lays out an express conditional statement in the form of “if, then “If the Secretary, after reasonable notice and opportunity for hearing,” determines that the State is not in compliance with the Medicaid-expansion rеquirements, the Secretary “shall notify such State agency that further payments will not be made to the State.”
The majority thinks it unremarkable that Congress would condemn insurance markets in States with federally-created ■ Exchanges to an adverse-selection death spiral. It reaches this conclusion by observing that, in peripheral statutory provisions, Congress has twice created insurance markets that suffered from the defect of having guaranteed issue requirements without the other measures (such as a mandate or subsidies) necessary to ensure the soundness of the market. Congress did this, the majority notes, in the provisions covering the Northern Mariana Islands and other federal territories, see
This argument entirely misses the point. These peripheral statutory provisions say nothing about the core provisions of the ACA at issue here, as both the majority and the Appellants recognize. In both provisions, Congress purposely decided not to impose an individual mandate. That is a crucial difference. The Government and supporting amici’s position in this case relies on Congress’ express recognition that the individual mandate, “together with the other provisions of this Act, will minimize ... adverse selection,” and that, as such, the mandate “is essential to creating effective health insurance markets” with guaranteed-issue requirements.
Appellants suggest that because Congress enacted peripheral statutory provisions covering territories and in the
Appellants’ arguments to the contrary are perplexing, to say the least. Congress’ omissions of an individual mandate — which it recognized as an “essential” tool to prevent adverse selection,
The Government and supporting ami-ci ’s structural argument in this case cannot be dismissed as idle meanderings into legislative history. It is apparent from the statutory text of the ACA that Congress understood (1) the importance of a broadly applicable individual mandate that works “together with the other provisions” to ensure the viability of an insurance market against the threat of adverse selection,
2. The Advance Payment Reporting Requirements of
One of the subsections in § 36B — which is the section upon which Appellants stake their case — makes it clear that Congress intended that taxpayers on HHS-created Exchanges would be eligible for subsidies. Subsection (f), entitled “Reconciliation of credit and advance credit,” tasks the IRS with reducing the amount of a taxpayer’s end-of-year premium tax credit under
Appellants’ attempts to minimize the importance of the reporting requirements are specious. They first argue that, even if credits are unavailable on federally-created Exchanges, the reporting provision would nevertheless serve a purpose: to enforce the individual mandate to buy insurance. This amounts to a sleight of hand. The argument ignores the clear purpose — apparent from the statutory text — of subsection (f) and its reporting requirements. The purpose is front and center in the subsection’s title — “Reconciliation of credit and advance credit,”
In a letter submitted to the court before oral argument, Appellants cited an IRS regulation,
Appellants also argue that the reporting provisions in subsection
3. Other Provisions
There are two other provisions of the ACA that strongly support the Government’s claim that the statute, read as a whole, permits taxpayers who purchase insurance in non-electing States to receive subsidies. First, the statute defines a “qualified individual” as a person who “resides in the State that established the Exchange.”
Second, in a subparagraph entitled “Assurance of exchange coverage for targeted low-income children unable to be provided child health assistance as a result of funding shortfalls,” the ACA requires States to “ensure” that low-income children who are not covered under the State’s child health plan are enrolled in a health plan that is offered through “an Exchange established by the State under [
In view of the foregoing, Appellants’ reliance on Bay Mills is entirely misplaced. In citing that case, Appellants simply cherry pick language which appears favorable
C. Appellants’ Extraordinary Subsidies-As-Incentive Argument
The foregoing examination of the statute shows that when the terms of
The record indicates that, when the ACA was enacted, no State even considered the possibility that its taxpayers would be denied subsidies if the State opted to allow HHS to establish an Exchange on its behalf. Not one. Indeed no State even suggested that a lack of subsidies factored into its decision whether to create its own Exchange. Br. of Members of Congress and State Legislatures at 24-25 & n.30 (citing authorities). “States were motivated by a mix of policy considerations, such as flexibility and control, and ‘strategic’ calculations by ACA opponents, not the availability of tax credits.” Id. at 24-25 n. 30 (citing authorities). The fact that all States recognized and protested the Medicaid expansion condition, while no State raised any concern over the purported subsidy-condition shows that Appellants’ argument is at best fanciful. See Br. for the Appellees at 42 (“[T]he twenty-six plaintiff states in [Nat’l Fed’n of Indep. Bus.,
The legislative history also indicates that Congress assumed subsidies would be available on HHS-created Exchanges. First, earlier proposals for the legislation and an earlier version of the House Bill provided that the federal government would establish and operate Exchanges. Halbig v. Sebelius, — F.Supp.3d -, -,
In addition, the three House Committees with jurisdiction over the ACA legislation issued a fact sheet explaining that States would have a choice whether to create their own Exchanges or have one run by the federal government, and “the Exchanges” would make health insurance more affordable. The fact sheet recognized income level as the only criteria for subsidy-eligibility. Br. for Members of Congress and State Legislatures at 11-12. The Joint Committee on Taxation also reported that the subsidies would be available to those who purchase insurance through “an exchange.” Id. at 12. And Congressional Budget Office estimates assumed that subsidies would be available nationwide. Letter from Douglas W. El-mendorf, Director, CBO, to Rep. Darrell E. Issa, Chairman, House Committee on Oversight and Government Reform (Dec. 6, 2012) (“To the best of our recollection, the possibility that those subsidies would only be available in states that created their own exchanges did not arise during the discussions CBO staff had with a wide range of Congressional staff'when the legislation was being considered.” (emphasis added)).
The truth is that there is nothing in the record indicating that, aside from wanting to afford States flexibility, Congress preferred State-run to HHS-run Exchanges. Appellants have not explained why Congress would want to encourage States to operate Exchanges rather than the federal government doing so, nor is there any indication that Congress had this goal. “[T]he purpose of the tax credits was not to encourage States to set up their own Exchanges. Indeed, making the tax credits conditional on state establishment of the Exchanges would have empowered hostile state officials to undermine the core purpose of the ACA, a result that [the] architects of the ACA wanted to avoid, not encourage.” Br. for Members of Congress and State Legislatures at 22.
Furthermore, Appellants assume without any basis that denying taxpayers premium subsidies would put political pressure on States to create Exchanges. This assumption runs counter to Appellants’ own theory of harm: After all, Appellants object to the subsidies because they impose additional financial obligations on individuals and employers by triggering the individual mandate and assessable payments for employers. These obligations would not attach if the subsidies were not available in the State. Because the subsidies trigger additional costs for individuals and employers, it is not obvious that they would be popular among taxpayers or cause taxpayers to pressure their States to create Exchanges.
The single piece of evidence that Appellants cite to support their claim that Congress intended to restrict subsidies to State-run Exchanges is an article by a law professor. Br. for Appellants at 40 (citing Timothy S. Jost, Health Insurance Exchanges: Legal Issues, O’Neill Inst., Georgetown Univ. Legal Ctr., no. 23 (Apr. 7, 2009)). There is no evidence, however, that anyone in Congress read, cited, or relied on this article.
III. Conclusion
The Supreme Court has made it clear that “[t]he plainness or ambiguity of statu
The IRS’s and HHS’s constructions of the statute are perfectly consistent with the statute’s text, structure, and purpose, while Appellants’ interpretation would “crumble” the Act’s structure. Therefore, we certainly cannot hold that that the agencies’ regulations are “manifestly contrary to the statute.” This court owes deference to the agencies’ interpretations of the ACA. Unfortunately, by imposing the Appellants’ myopic construction on the administering agencies without any regard for the overall statutory scheme, the majority opinion effectively ignores the basic tenets of statutory construction, as well as the principles of Chevron deference. Because the proposed judgment of the majority defies the will of Congress and the permissible interpretations of the agencies to whom Congress has delegated the authority to interpret and enforce the terms of the ACA, I dissent.
Concurrence Opinion
concurring:
A Supreme Court tax decision, and a tax decision of this court, flatly reject the position the government takes in this case.
As Judge Griffith’s majority opinion— which I fully join — demonstrates, an Exchange established by the federal government cannot possibly be “an Exchange established by the State.” To hold otherwise would be to engage in distortion, not interpretation. Only further legislation could accomplish the expansion the government seeks.
In the meantime, Justice Brandéis’ opinion for the Supreme Court in Iselin v. United States is controlling: “What the government asks is not a construction of a statute, but, in effect, an enlargement of it by the court, so that what was omitted, presumably by inadvertence, may be included within its scope. To supply omissions transcends the judicial function.”