United States: Round And Round And Round She Goes, And Where She Lands, Nobody Knows: The Future Of Obamacare And Why King V. Burwell Matters – A Five-Part Series

Last week, on Wednesday, March 4, the U.S. Supreme Court heard oral argument in the highly publicized case of King. v. Burwell—a lawsuit challenging the Affordable Care Act or "Obamacare" based upon what many would call the most pernicious of statutory problems – poor drafting.

The exact issue presented to the Supreme Court by the King petition is "whether the IRS may permissibly promulgate regulations to extend tax-credit subsidies to healthcare coverage purchased through Exchanges established by the federal government under section 1321 of the ACA."1 At first glance (and maybe even at the second, third, and fourth glance), this may seem to be a highly-technical issue of tax and administrative law.  However, for every professional and armchair constitutional law pundit out there, the issue – Federalism – goes to the core of who we are as a country.

Putting aside King's larger historical/political context and its legal niceties, the real issue in King is whether qualifying low-income individuals and families who obtain healthcare coverage through a federal Exchange (an Exchange created by the federal government for the residents of states that have decided not to create their own state Exchanges) are eligible to receive federal premium subsidies.  Without access to such premium subsidies, millions of low income individuals and families would be unable to afford healthcare coverage under the ACA.  As a result, many argue that one of the primary purposes of the ACA – increasing access to high quality, cost effective healthcare services by increasing access to healthcare coverage – would be substantially thwarted if the Court's ultimate decisions were to side with the petitioners.

Given the stakes, it is not surprising that political commentators on both sides of the aisle have employed sensationalist rhetoric to describe the King case and the potential consequences of a ruling for the petitioners and against the availability of premium subsidies for coverage provided on the federal Exchanges.  On the left, commentators warn of millions of Americans losing insurance coverage, with some claiming that nearly 10,000 Americans would needlessly lose their lives each year if the Supreme Court were to uphold the petitioners' challenge.2 Such pro-ACA commentators argue that a ruling for the petitioners—combined with continued Congressional dysfunction—would send the United States' health care system into the so-called "Death Spiral" resulting in skyrocketing premiums that would not only (1) push currently-subsidized beneficiaries out of the ACA healthcare coverage marketplace, but would also (2) negatively impact individuals who currently have ACA healthcare coverage without the need for federal premium subsidies.3

Other ACA supporters mock the substance of the legal arguments themselves, characterizing the petitioners' case as one built on right wing sound bites and fabricated history.4 For their part, conservative pundits decry the left-wing's "scare tactics" and claims that "the sky will fall" if the Court finds for the health law's challengers.5 They urge Americans not to be bamboozled by ACA supporters' dramatic predictions of catastrophe, and argue that a ruling for the petitioners will simply force the Obama administration to negotiate with Congress and allow major changes to the currently unworkable healthcare law.6

As evidenced by last week's comments from the bench, the Justices themselves seemed to be taking a more moderate view.  Justice Scalia, for example, acknowledged the potential for such "disastrous consequences" but placed some degree of trust in Congressional action to address them.7 Indeed, some prominent Republican legislators have already announced their intention to find a legislative solution to the potential fallout from a ruling for the petitioners.  There is also the possibility—floated by Justice Alito—that the fallout from a ruling in favor of the King petitioners might persuade states to establish their own Exchanges so as to allow their residents undisputed access to the federal premium subsidies.8

To both engage and edify our faithful readers and to keep the Sheppard Mullin healthcare team from biting their nails to the quick while waiting for the Court's ruling, we are preparing a short series of blog posts to examine the possible impacts a King Supreme Court decision could have on the various stakeholders in the U.S. healthcare marketplace.  More specifically, in the coming weeks, you will be consuming and be consumed by the following commentaries on the King case:

  • Week 1 will address the possible effects of the Supreme Court's decision on healthcare consumers including those individuals who currently access healthcare coverage through the federal Exchanges;
  • Week 2 will focus our attention on how the King decision may impact healthcare providers and suppliers;
  • Week 3 will address the concerns of employers who are subject to the ACA's "employer mandate"; and
  • Week 4 will conclude our series with King-related predictions from members of the Sheppard Mullin healthcare team and other U.S. healthcare legal and policy thought leaders.  Although we have told our prognosticators that there will be no prizes for the pundit with the most accurate prediction, we have no doubt that the usual contest of egos will provide some insightful and thought provoking possibilities to ponder. Perhaps.


1 "Question Presented," Petition for Certiorari to the Fourth Circuit, King v. Burwell at i.

2 http://www.huffingtonpost.com/dr-georges-c-benjamin/king-v-burwell-supreme-court_b_6787460.html .

3 http://www.nytimes.com/2015/03/02/upshot/how-an-adverse-supreme-court-ruling-would-send-obamacare-into-a-tailspin.html?abt=0002&abg=0 .

4 http://www.newrepublic.com/article/121107/king-burwell-obamacare-challenge-fox-news-baby .

5 http://www.breitbart.com/big-government/2015/03/02/exclusive-final-hours-of-obamacare/ .

6 http://www.foxnews.com/opinion/2015/03/02/king-vs-burwell-get-ready-for-obamacare-winners-and-losers/ .

7Oral Argument, King v. Burwell at 47:15-19, 54:9-55:3.

8 Id. at 52:2-10.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Events from this Firm
29 Nov 2017, Webinar, Los Angeles, United States

This webinar will cover issues that California employers must face when managing a remote workforce of employees who “telecommute” for work. Due to the growing number of employees that work from home, California employers must know how to manage this new remote workforce in order to offer competitive career opportunities for a new generation of employees, while also being careful not to violate the complex California employment laws that govern these work arrangements.

30 Nov 2017, Conference, Brussels, Belgium

The European Competition and Regulatory Law Review (CoRe), the Computer and Communications Industry Association (CCIA) and the Vrije Universiteit Brussel (VUB) are delighted to invite you to our joint conference discussing some of today’s most frequently asked questions: Does competition law enforcement require an update for online markets?

4 Dec 2017, Conference, Virginia, United States

The Government Contract Management Symposium (GCMS) is held annually by the National Contract Management Association (NCMA) in the Washington, DC metro area. Formerly intended for those in federal sector, it has grown to provide training for professionals in both government and industry contracting.

In association with
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


From time to time Mondaq may send you emails promoting Mondaq services including new services. You may opt out of receiving such emails by clicking below.

*** If you do not wish to receive any future announcements of services offered by Mondaq you may opt out by clicking here .


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.