SUPREME COURT OF THE UNITED STATES : Syllabus : KING ET AL. v. BURWELL, SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL.

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HEALTH CARE REFORM :

UNITED STATES: POLITICS: POLITICAL PARTIES: REPUBLICAN PARTY, TEA PARTY :

INDUSTRIES: PETROLEUM :

LIBRETARIANISM :

MEDICAL INSURANCE: MEDICAID :

HEALTH INSURANCE :

LAW: CASE: DECISIONS:

SUPREME COURT OF THE UNITED STATES :
Syllabus : KING ET AL. v. BURWELL,
SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL.

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SUPREME COURT OF THE UNITED STATES :
Syllabus : KING ET AL. v. BURWELL,
SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL.


THE COMPLETE DOCUMENT WILL BE FOUND HERE:

http://www.supremecourt.gov/opinions/14pdf/14-114_qol1.pdf

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(Slip Opinion)

OCTOBER TERM, 2014

Syllabus

NOTE: Where it is feasible, a syllabus (headnote) will be released, as 
isbeing done in connection with this case, at the time the opinion is 
issued.The syllabus constitutes no part of the opinion of the Court but 
has beenprepared by the Reporter of Decisions for the convenience of the 
reader. See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 
337.

SUPREME COURT OF THE UNITED STATES

Syllabus

KING ET AL. v. BURWELL, SECRETARY OF HEALTH
AND HUMAN SERVICES, ET AL.
CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 14-114. Argued March 4, 2015-Decided June 25, 2015

The Patient Protection and Affordable Care Act grew out of a long history 
of failed health insurance reform. In the 1990s, several States sought to 
expand access to coverage by imposing a pair of insurance market 
regulations-a "guaranteed issue" requirement, which bars insurers from 
denying coverage to any person because of his health,and a "community 
rating" requirement, which bars insurers fromcharging a person higher 
premiums for the same reason. The reforms achieved the goal of expanding 
access to coverage, but they also encouraged people to wait until they got 
sick to buy insurance. The result was an economic "death spiral": premiums 
rose, the number of people buying insurance declined, and insurers left 
the market entirely. In 2006, however, Massachusetts discovered a way to 
makethe guaranteed issue and community rating requirements work-by 
requiring individuals to buy insurance and by providing tax credits to 
certain individuals to make insurance more affordable. The combination of 
these three reforms-insurance market regulations, a coverage mandate, and 
tax credits-enabled Massachusetts to drastically reduce its uninsured 
rate. The Affordable Care Act adopts a version of the three key reforms 
that made the Massachusetts system successful. First, the Act adopts the 
guaranteed issue and community rating requirements. 42
U. S. C. 300gg, 300gg-1. Second, the Act generally requires individuals to 
maintain health insurance coverage or make a payment tothe IRS, unless the 
cost of buying insurance would exceed eight percent of that individual's 
income. 26 U. S. C. 5000A. And third, the Act seeks to make insurance more 
affordable by giving refundable tax credits to individuals with household 
incomes between 100 per2
KING v. BURWELL


Syllabus

cent and 400 percent of the federal poverty line. 36B.
In addition to those three reforms, the Act requires the creation of an 
"Exchange" in each State-basically, a marketplace that allowspeople to 
compare and purchase insurance plans. The Act gives each State the 
opportunity to establish its own Exchange, but provides that the Federal 
Government will establish "such Exchange" if the State does not. 42 U. S. 
C. 18031, 18041. Relatedly, the Act provides that tax credits "shall be 
allowed" for any "applicable taxpayer,"26 U. S. C. 36B(a), but only if the 
taxpayer has enrolled in an insurance plan through "an Exchange 
established by the State under [42
U. S. C. 18031]," 36B(b)-(c). An IRS regulation interprets thatlanguage as 
making tax credits available on "an Exchange," 26 CFR1.36B-2, "regardless 
of whether the Exchange is established andoperated by a State . . . or by 
HHS," 45 CFR 155.20.
Petitioners are four individuals who live in Virginia, which has aFederal 
Exchange. They do not wish to purchase health insurance. In their view, 
Virginia's Exchange does not qualify as "an Exchangeestablished by the 
State under [42 U. S.


C. 18031]," so they should not receive any tax credits. That would make 
the cost of buying insurance more than eight percent of petitioners' 
income, exemptingthem from the Act's coverage requirement. As a result of 
the IRS Rule, however, petitioners would receive tax credits. That would 
make the cost of buying insurance less than eight percent of their income, 
which would subject them to the Act's coverage requirement.
Petitioners challenged the IRS Rule in Federal District Court. The 
District Court dismissed the suit, holding that the Act unambiguously made 
tax credits available to individuals enrolled through a Federal Exchange. 
The Court of Appeals for the Fourth Circuit affirmed.The Fourth Circuit 
viewed the Act as ambiguous, and deferred to theIRS's interpretation under 
Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 U. 
S. 837.
Held: Section 36B's tax credits are available to individuals in States 
that have a Federal Exchange. Pp. 7-21.


(a) When analyzing an agency's interpretation of a statute, thisCourt 
often applies the two-step framework announced in Chevron, 467 U. S. 837. 
But Chevron does not provide the appropriate framework here. The tax 
credits are one of the Act's key reforms andwhether they are available on 
Federal Exchanges is a question ofdeep "economic and political 
significance"; had Congress wished toassign that question to an agency, it 
surely would have done so expressly. And it is especially unlikely that 
Congress would have delegated this decision to the IRS, which has no 
expertise in craftinghealth insurance policy of this sort.
It is instead the Court's task to determine the correct reading of
Cite as: 576 U. S. ____ (2015) 3


Syllabus


Section 36B. If the statutory language is plain, the Court must enforce it 
according to its terms. But oftentimes the meaning-or ambiguity-of certain 
words or phrases may only become evident when placed in context. So when 
deciding whether the language is plain,the Court must read the words "in 
their context and with a view to their place in the overall statutory 
scheme." FDA v. Brown & Williamson Tobacco Corp., 529 U. S. 120, 133. Pp. 
7-9.


(b)


When read in context, the phrase "an Exchange established bythe State 
under [42 U. S. C. 18031]" is properly viewed as ambiguous. The phrase may 
be limited in its reach to State Exchanges. But it could also refer to all 
Exchanges-both State and Federal-forpurposes of the tax credits. If a 
State chooses not to follow the directive in Section 18031 to establish an 
Exchange, the Act tells the Secretary of Health and Human Services to 
establish "such Exchange." 18041. And by using the words "such Exchange," 
the Act indicates that State and Federal Exchanges should be the same. But 
State and Federal Exchanges would differ in a fundamental way iftax 
credits were available only on State Exchanges-one type of Exchange would 
help make insurance more affordable by providing billions of dollars to 
the States' citizens; the other type of Exchange would not. Several other 
provisions in the Act-e.g., Section 18031(i)(3)(B)'s requirement that all 
Exchanges create outreach programs to "distribute fair and impartial 
information concerning . . . the availability of premium tax credits under 
section 36B"-would make little sense if tax credits were not available on 
Federal Exchanges.
The argument that the phrase "established by the State" would 
besuperfluous if Congress meant to extend tax credits to both State 
andFederal Exchanges is unpersuasive. This Court's "preference for 
avoiding surplusage constructions is not absolute." Lamie v. United States 
Trustee, 540 U. S. 526, 536. And rigorous application of thatcanon does 
not seem a particularly useful guide to a fair constructionof the 
Affordable Care Act, which contains more than a few examples of inartful 
drafting. The Court nevertheless must do its best, "bearing in mind the 
'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.' " Utility Air Regulatory Group v. EPA, 573 U. 
S. ___, ___. Pp. 9-15.


(c)


Given that the text is ambiguous, the Court must look to the broader 
structure of the Act to determine whether one of Section 36B's 
"permissible meanings produces a substantive effect that is compatible 
with the rest of the law." United Sav. Assn. of Tex. v. Timbers of Inwood 
Forest Associates, Ltd., 484 U. S. 365, 371.
Here, the statutory scheme compels the Court to reject petitioners'
4 KING v. BURWELL


Syllabus interpretation because it would destabilize the individual 
insurance market in any State with a Federal Exchange, and likely create 
the very "death spirals" that Congress designed the Act to avoid. Under 
petitioners' reading, the Act would not work in a State with a Federal 
Exchange. As they see it, one of the Act's three major reforms-the tax 
credits-would not apply. And a second major reform-the coverage 
requirement-would not apply in a meaningful way, because somany 
individuals would be exempt from the requirement without the tax credits. 
If petitioners are right, therefore, only one of the Act's three major 
reforms would apply in States with a Federal Exchange.
The combination of no tax credits and an ineffective coverage requirement 
could well push a State's individual insurance market intoa death spiral. 
It is implausible that Congress meant the Act to operate in this manner. 
Congress made the guaranteed issue and community rating requirements 
applicable in every State in the Nation, but those requirements only work 
when combined with the coverage requirement and tax credits. It thus 
stands to reason that Congress meant for those provisions to apply in 
every State as well.Pp. 15-19.


(d) The structure of Section 36B itself also suggests that tax creditsare 
not limited to State Exchanges. Together, Section 36B(a), which allows tax 
credits for any "applicable taxpayer," and Section36B(c)(1), which defines 
that term as someone with a household income between 100 percent and 400 
percent of the federal povertyline, appear to make anyone in the specified 
income range eligible fora tax credit. According to petitioners, however, 
those provisions are an empty promise in States with a Federal Exchange. 
In their view, an applicable taxpayer in such a State would be eligible 
for a tax credit, but the amount of that tax credit would always be zero 
because of two provisions buried deep within the Tax Code. That argument 
fails because Congress "does not alter the fundamental details of a 
regulatory scheme in vague terms or ancillary provisions." Whitman v. 
American Trucking Assns., Inc., 531 U. S. 457. Pp. 19-
20.


(e) Petitioners' plain-meaning arguments are strong, but the Act'scontext 
and structure compel the conclusion that Section 36B allows tax credits 
for insurance purchased on any Exchange created under the Act. Those 
credits are necessary for the Federal Exchanges tofunction like their 
State Exchange counterparts, and to avoid thetype of calamitous result 
that Congress plainly meant to avoid.Pp. 20-21.
759 F. 3d 358, affirmed.


ROBERTS, C. J., delivered the opinion of the Court, in which KEN5
Cite as: 576 U. S. ____ (2015) Syllabus NEDY, GINSBURG, BREYER, SOTOMAYOR, 
and KAGAN, JJ., joined. SCALIA, J., filed a dissenting opinion, in which 
THOMAS and ALITO, JJ., joined

Site as: 576 U. S. ____ (2015) 1

Opinion of the Court

NOTICE: This opinion is subject to formal revision before publication in 
thepreliminary print of the United States Reports. Readers are requested 
tonotify the Reporter of Decisions, Supreme Court of the United States, 
Washington, D. C. 20543, of any typographical or other formal errors, in 
orderthat corrections may be made before the preliminary print goes to 
press.

SUPREME COURT OF THE UNITED STATES

No. 14-114

DAVID KING, ET AL., PETITIONERS v. SYLVIA BURWELL, SECRETARY OF HEALTH AND 
HUMAN SERVICES, ET AL.

ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF

APPEALS FOR THE FOURTH CIRCUIT

[June 25, 2015]

CHIEF JUSTICE ROBERTS delivered the opinion of theCourt.
The Patient Protection and Affordable Care Act adopts a series of 
interlocking reforms designed to expand coveragein the individual health 
insurance market. First, the Act bars insurers from taking a person's 
health into accountwhen deciding whether to sell health insurance or how 
much to charge. Second, the Act generally requires each person to maintain 
insurance coverage or make a payment to the Internal Revenue Service. And 
third, the Act gives tax credits to certain people to make insurance 
moreaffordable.

In addition to those reforms, the Act requires the creation of an 
"Exchange" in each State-basically, a marketplace that allows people to 
compare and purchase insurance plans. The Act gives each State the 
opportunity toestablish its own Exchange, but provides that the Federal 
Government will establish the Exchange if the State does not.
This case is about whether the Act's interlocking re2

KING v. BURWELL

Opinion of the Court

forms apply equally in each State no matter who establishes the State's 
Exchange. Specifically, the question pre- sented is whether the Act's tax 
credits are available in States that have a Federal Exchange.
I
A

The Patient Protection and Affordable Care Act, 124 Stat. 119, grew out of 
a long history of failed health insurance reform. In the 1990s, several 
States began experimenting with ways to expand people's access to 
coverage.One common approach was to impose a pair of insurancemarket 
regulations-a "guaranteed issue" requirement,which barred insurers from 
denying coverage to any person because of his health, and a "community 
rating" requirement, which barred insurers from charging a personhigher 
premiums for the same reason. Together, those requirements were designed 
to ensure that anyone whowanted to buy health insurance could do so.
The guaranteed issue and community rating requirements achieved that goal, 
but they had an unintended consequence: They encouraged people to wait 
until theygot sick to buy insurance. Why buy insurance coverage when you 
are healthy, if you can buy the same coveragefor the same price when you 
become ill? This consequence-known as "adverse selection"-led to a second: 
Insurers were forced to increase premiums to account for the fact that, 
more and more, it was the sick rather than the healthy who were buying 
insurance. And that consequence fed back into the first: As the cost of 
insurance rose, even more people waited until they became ill tobuy it.
This led to an economic "death spiral." As premiums rose higher and 
higher, and the number of people buying insurance sank lower and lower, 
insurers began to leave the market entirely. As a result, the number of 
people

Cite as: 576 U. S. ____ (2015) 3

Opinion of the Court

without insurance increased dramatically.

This cycle happened repeatedly during the 1990s. For example, in 1993, the 
State of Washington reformed itsindividual insurance market by adopting 
the guaranteed issue and community rating requirements. Over the next 
three years, premiums rose by 78 percent and the numberof people enrolled 
fell by 25 percent. By 1999, 17 of theState's 19 private insurers had left 
the market, and theremaining two had announced their intention to do so. 
Brief for America's Health Insurance Plans as Amicus Curiae 10-11.
For another example, also in 1993, New York adopted the guaranteed issue 
and community rating requirements. Over the next few years, some major 
insurers in the individual market raised premiums by roughly 40 percent. 
By1996, these reforms had "effectively eliminated the commercial 
individual indemnity market in New York withthe largest individual health 
insurer exiting the market."

L. Wachenheim & H. Leida, The Impact of Guaranteed Issue and Community 
Rating Reforms on States' Individual Insurance Markets 38 (2012).

In 1996, Massachusetts adopted the guaranteed issueand community rating 
requirements and experienced similar results. But in 2006, Massachusetts 
added two more reforms: The Commonwealth required individuals to buy 
insurance or pay a penalty, and it gave tax credits tocertain individuals 
to ensure that they could afford the insurance they were required to buy. 
Brief for Bipartisan Economic Scholars as Amici Curiae 24-25. The 
combination of these three reforms-insurance market regulations, a 
coverage mandate, and tax credits-reduced the uninsured rate in 
Massachusetts to 2.6 percent, by far the lowest in the Nation. Hearing on 
Examining IndividualState Experiences with Health Care Reform 
CoverageInitiatives in the Context of National Reform before the Senate 
Committee on Health, Education, Labor, and

4 KING v. BURWELL

Opinion of the Court

Pensions, 111th Cong., 1st Sess., 9 (2009).

B The Affordable Care Act adopts a version of the three key reforms that 
made the Massachusetts system successful. First, the Act adopts the 
guaranteed issue and community rating requirements. The Act provides that 
"eachhealth insurance issuer that offers health insurance coverage in the 
individual . . . market in a State must accept every . . . individual in 
the State that applies for suchcoverage." 42 U. S. C. 300gg-1(a). The Act 
also bars insurers from charging higher premiums on the basis of a 
person's health. 300gg.Second, the Act generally requires individuals to 
maintain health insurance coverage or make a payment to theIRS. 26 U. S. 
C. 5000A. Congress recognized that, without an incentive, "many 
individuals would wait to purchase health insurance until they needed 
care." 42
U. S. C. 18091(2)(I). So Congress adopted a coverage requirement to 
"minimize this adverse selection and broaden the health insurance risk 
pool to include healthy individuals, which will lower health insurance 
premiums." Ibid. In Congress's view, that coverage requirement 
was"essential to creating effective health insurance markets." Ibid. 
Congress also provided an exemption from the coverage requirement for 
anyone who has to spend more thaneight percent of his income on health 
insurance. 26

U. S. C. 5000A(e)(1)(A), (e)(1)(B)(ii).

Third, the Act seeks to make insurance more affordable by giving 
refundable tax credits to individuals with household incomes between 100 
percent and 400 percent of the federal poverty line. 36B. Individuals who 
meet the Act's requirements may purchase insurance with the tax credits, 
which are provided in advance directly to the individual's insurer. 42 U. 
S. C. 18081, 18082.

These three reforms are closely intertwined. As noted,

Cite as: 576 U. S. ____ (2015) 5

Opinion of the Court

Congress found that the guaranteed issue and community rating requirements 
would not work without the coveragerequirement. 18091(2)(I). And the 
coverage requirementwould not work without the tax credits. The reason is 
that, without the tax credits, the cost of buying insurancewould exceed 
eight percent of income for a large number of individuals, which would 
exempt them from the coverage requirement. Given the relationship between 
these three reforms, the Act provided that they should take effect onthe 
same day-January 1, 2014. See Affordable Care Act,1253, redesignated 1255, 
124 Stat. 162, 895; 1401(e),1501(d), id., at 220, 249.

C In addition to those three reforms, the Act requires the creation of an 
"Exchange" in each State where peoplecan shop for insurance, usually 
online. 42 U. S. C. 18031(b)(1). An Exchange may be created in one of two 
ways. First, the Act provides that "[e]ach State shall . . . establish an 
American Health Benefit Exchange . . . for the State." Ibid. Second, if a 
State nonetheless chooses not to establish its own Exchange, the Act 
provides that the Secretary of Health and Human Services "shall . . 
.establish and operate such Exchange within the State." 18041(c)(1).The 
issue in this case is whether the Act's tax credits are available in 
States that have a Federal Exchangerather than a State Exchange. The Act 
initially providesthat tax credits "shall be allowed" for any "applicable 
taxpayer." 26 U. S. C. 36B(a). The Act then providesthat the amount of the 
tax credit depends in part on whether the taxpayer has enrolled in an 
insurance plan through "an Exchange established by the State under section 
1311 of the Patient Protection and Affordable Care Act [hereinafter 42 U. 
S. C. 18031]." 26 U. S. C. 36B(b)-(c) (emphasis added).

6 KING v. BURWELL

Opinion of the Court

The IRS addressed the availability of tax credits bypromulgating a rule 
that made them available on both State and Federal Exchanges. 77 Fed. Reg. 
30378 (2012).As relevant here, the IRS Rule provides that a taxpayer 
iseligible for a tax credit if he enrolled in an insurance plan through 
"an Exchange," 26 CFR 1.36B-2 (2013), which is defined as "an Exchange 
serving the individual market . . . regardless of whether the Exchange is 
established and operated by a State . . . or by HHS," 45 CFR 155.20 
(2014). At this point, 16 States and the District of Columbia have 
established their own Exchanges; the other 34States have elected to have 
HHS do so.

D Petitioners are four individuals who live in Virginia,which has a 
Federal Exchange. They do not wish to purchase health insurance. In their 
view, Virginia's Exchange does not qualify as "an Exchange established by 
the State under [42 U. S. C. 18031]," so they should not receive any tax 
credits. That would make the cost of buying insurance more than eight 
percent of their income,which would exempt them from the Act's coverage 
requirement. 26 U. S. C. 5000A(e)(1). Under the IRS Rule, however, 
Virginia's Exchange would qualify as "an Exchange established by the State 
under [42 U. S. C. 18031]," so petitioners would receive tax credits. That 
would make the cost of buying insurance less than eight percent of 
petitioners' income, which would subject them to the Act's coverage 
requirement.

The IRS Rule therefore requires petitioners to either buy healthinsurance 
they do not want, or make a payment to the IRS. Petitioners challenged the 
IRS Rule in Federal DistrictCourt. The District Court dismissed the suit, 
holding that the Act unambiguously made tax credits available to 
individuals enrolled through a Federal Exchange. King v.

Cite as: 576 U. S. ____ (2015) 7

Opinion of the Court

Sebelius, 997 F. Supp. 2d 415 (ED Va. 2014). The Court of Appeals for the 
Fourth Circuit affirmed. 759 F. 3d 358 (2014). The Fourth Circuit viewed 
the Act as "ambiguousand subject to at least two different 
interpretations." Id., at 372. The court therefore deferred to the IRS's 
interpretation under Chevron U. S. A. Inc. v. Natural Resources Defense 
Council, Inc., 467 U. S. 837 (1984). 759 F. 3d, at
376.

The same day that the Fourth Circuit issued its decision, the Court of 
Appeals for the District of Columbia Circuit vacated the IRS Rule in a 
different case, holding that the Act "unambiguously restricts" the tax 
credits to State Exchanges. Halbig v. Burwell, 758 F. 3d 390, 394 (2014). 
We granted certiorari in the present case. 574
U. S. ___ (2014).

II The Affordable Care Act addresses tax credits in what is now Section 
36B of the Internal Revenue Code. That section provides: "In the case of 
an applicable taxpayer, there shall be allowed as a credit against the tax 
imposed by this subtitle . . . an amount equal to the premium assistance 
credit amount." 26 U. S. C. 36B(a). Section 36B then defines the term 
"premium assistance credit amount"as "the sum of the premium assistance 
amounts determined under paragraph (2) with respect to all coverage months 
of the taxpayer occurring during the taxable year." 36B(b)(1) (emphasis 
added). Section 36B goes on to define the two italicized terms-"premium 
assistance amount" and "coverage month"-in part by referring to 
aninsurance plan that is enrolled in through "an Exchangeestablished by 
the State under [42 U. S. C. 18031]." 26

U. S. C. 36B(b)(2)(A), (c)(2)(A)(i).

The parties dispute whether Section 36B authorizes taxcredits for 
individuals who enroll in an insurance planthrough a Federal Exchange. 
Petitioners argue that a

8 KING v. BURWELL

Opinion of the Court

Federal Exchange is not "an Exchange established by the State under [42 U. 
S. C. 18031]," and that the IRS Rule therefore contradicts Section 36B. 
Brief for Petitioners 18-20. The Government responds that the IRS Rule is 
lawful because the phrase "an Exchange established by the State under [42 
U. S. C. 18031]" should be read toinclude Federal Exchanges. Brief for 
Respondents 20-25.

When analyzing an agency's interpretation of a statute,we often apply the 
two-step framework announced in Chevron, 467 U. S. 837. Under that 
framework, we ask whether the statute is ambiguous and, if so, whether the 
agency's interpretation is reasonable. Id., at 842-843. This approach "is 
premised on the theory that a statute's ambiguity constitutes an implicit 
delegation from Congress to the agency to fill in the statutory gaps." FDA 
v. Brown & Williamson Tobacco Corp., 529 U. S. 120, 159 (2000). "In 
extraordinary cases, however, there may bereason to hesitate before 
concluding that Congress hasintended such an implicit delegation." Ibid.
This is one of those cases. The tax credits are among the Act's key 
reforms, involving billions of dollars in spending each year and affecting 
the price of health insurance for millions of people. Whether those 
credits are available on Federal Exchanges is thus a question of 
deep"economic and political significance" that is central to this 
statutory scheme; had Congress wished to assign that question to an 
agency, it surely would have done so expressly. Utility Air Regulatory 
Group v. EPA, 573 U. S. ___, ___ (2014) (slip op., at 19) (quoting Brown & 
Williamson, 529 U. S., at 160). It is especially unlikely that Congress 
would have delegated this decision to the IRS, which has no expertise in 
crafting health insurance policy of this sort. See Gonzales v. Oregon, 546 
U. S. 243, 266-267 (2006). This is not a case for the IRS.

It is instead our task to determine the correct reading ofSection 36B. If 
the statutory language is plain, we must

Cite as: 576 U. S. ____ (2015) 9

Opinion of the Court

enforce it according to its terms. Hardt v. Reliance Standard Life Ins. 
Co., 560 U. S. 242, 251 (2010). But oftentimes the "meaning-or 
ambiguity-of certain words or phrases may only become evident when placed 
in context." Brown & Williamson, 529 U. S., at 132. So when 
decidingwhether the language is plain, we must read the words "in their 
context and with a view to their place in the overall statutory scheme." 
Id., at 133 (internal quotation marks omitted). Our duty, after all, is 
"to construe statutes, not isolated provisions." Graham County Soil and 
Water Conservation Dist. v. United States ex rel. Wilson, 559

U. S. 280, 290 (2010) (internal quotation marks omitted).

A We begin with the text of Section 36B. As relevant here, Section 36B 
allows an individual to receive tax credits only if the individual enrolls 
in an insurance plan through"an Exchange established by the State under 
[42 U. S. C. 18031]." In other words, three things must be true: First,the 
individual must enroll in an insurance plan through"an Exchange." Second, 
that Exchange must be "established by the State." And third, that Exchange 
must beestablished "under [42 U. S. C. 18031]." We address each 
requirement in turn.First, all parties agree that a Federal Exchange 
qualifies as "an Exchange" for purposes of Section 36B. See Brief for 
Petitioners 22; Brief for Respondents 22. Section 18031 provides that 
"[e]ach State shall . . . establish anAmerican Health Benefit Exchange . . 
. for the State." 18031(b)(1). Although phrased as a requirement, the Act 
gives the States "flexibility" by allowing them to "elect" whether they 
want to establish an Exchange. 18041(b). If the State chooses not to do 
so, Section 18041 providesthat the Secretary "shall . . . establish and 
operate such Exchange within the State." 18041(c)(1) (emphasisadded).

10 KING v. BURWELL

Opinion of the Court

By using the phrase "such Exchange," Section 18041 instructs the Secretary 
to establish and operate the same Exchange that the State was directed to 
establish underSection 18031. See Black's Law Dictionary 1661 (10th ed. 
2014) (defining "such" as "That or those; having just beenmentioned"). In 
other words, State Exchanges and Fed- eral Exchanges are equivalent-they 
must meet the same requirements, perform the same functions, and serve the 
same purposes. Although State and Federal Exchangesare established by 
different sovereigns, Sections 18031 and 18041 do not suggest that they 
differ in any meaningful way. A Federal Exchange therefore counts as 
"anExchange" under Section 36B.

Second, we must determine whether a Federal Exchange is "established by 
the State" for purposes of Section 36B. At the outset, it might seem that 
a FederalExchange cannot fulfill this requirement. After all, the Act 
defines "State" to mean "each of the 50 States and the District of 
Columbia"-a definition that does not include the Federal Government. 42 U. 
S. C. 18024(d). But when read in context, "with a view to [its] place in 
theoverall statutory scheme," the meaning of the phrase"established by the 
State" is not so clear. Brown & Williamson, 529 U. S., at 133 (internal 
quotation marks omitted).

After telling each State to establish an Exchange, Section 18031 provides 
that all Exchanges "shall make available qualified health plans to 
qualified individuals." 42

U. S. C. 18031(d)(2)(A). Section 18032 then defines the term "qualified 
individual" in part as an individual who "resides in the State that 
established the Exchange."18032(f)(1)(A). And that's a problem: If we give 
the phrase "the State that established the Exchange" its mostnatural 
meaning, there would be no "qualified individuals"on Federal Exchanges. 
But the Act clearly contemplates that there will be qualified individuals 
on every Exchange.

11 Cite as: 576 U. S. ____ (2015)

Opinion of the Court

As we just mentioned, the Act requires all Exchanges to"make available 
qualified health plans to qualified individuals"-something an Exchange 
could not do if there were no such individuals. 18031(d)(2)(A). And the 
Act tells the Exchange, in deciding which health plans to offer, to 
consider "the interests of qualified individuals . . . in theState or 
States in which such Exchange operates"-again, something the Exchange 
could not do if qualified individuals did not exist. 18031(e)(1)(B). This 
problem arises repeatedly throughout the Act. See, e.g., 
18031(b)(2)(allowing a State to create "one Exchange . . . for providing . 
. . services to both qualified individuals and qualified small employers," 
rather than creating separate Exchangesfor those two groups).1

These provisions suggest that the Act may not alwaysuse the phrase 
"established by the State" in its most natural sense. Thus, the meaning of 
that phrase may not be as clear as it appears when read out of context.
Third, we must determine whether a Federal Exchangeis established "under 
[42 U. S. C. 18031]." This too might seem a requirement that a Federal 
Exchange cannot fulfill, because it is Section 18041 that tells the 
Secretary when to "establish and operate such Exchange." But here again, 
the way different provisions in the statute interact suggests otherwise.

The Act defines the term "Exchange" to mean "an American Health Benefit 
Exchange established under section18031." 300gg-91(d)(21). If we import 
that definition
------ 1The dissent argues that one would "naturally read instructions 
about qualified individuals to be inapplicable to the extent a particular 
Exchange has no such individuals." Post, at 10-11 (SCALIA, J., 
dissenting). But the fact that the dissent's interpretation would make so 
manyparts of the Act "inapplicable" to Federal Exchanges is precisely what 
creates the problem. It would be odd indeed for Congress to write such 
detailed instructions about customers on a State Exchange, while having 
nothing to say about those on a Federal Exchange.

12 KING v. BURWELL

Opinion of the Court

into Section 18041, the Act tells the Secretary to "establish and operate 
such 'American Health Benefit Exchangeestablished under section 18031.'" 
That suggests that Section 18041 authorizes the Secretary to establish 
anExchange under Section 18031, not (or not only) under Section 18041. 
Otherwise, the Federal Exchange, bydefinition, would not be an "Exchange" 
at all. See Halbig, 758 F. 3d, at 399-400 (acknowledging that the 
Secretary establishes Federal Exchanges under Section 18031).

This interpretation of "under [42 U. S. C. 18031]" fits best with the 
statutory context. All of the requirementsthat an Exchange must meet are 
in Section 18031, so it issensible to regard all Exchanges as established 
under thatprovision. In addition, every time the Act uses the 
word"Exchange," the definitional provision requires that we substitute the 
phrase "Exchange established under section 18031." If Federal Exchanges 
were not established under Section 18031, therefore, literally none of the 
Act's requirements would apply to them. Finally, the Act repeatedly uses 
the phrase "established under [42 U. S. C.18031]" in situations where it 
would make no sense to distinguish between State and Federal Exchanges. 
See, e.g., 26 U. S. C. 125(f)(3)(A) (2012 ed., Supp. I) ("The 
term'qualified benefit' shall not include any qualified healthplan . . . 
offered through an Exchange established under [42 U. S. C. 18031]"); 26 U. 
S. C. 6055(b)(1)(B)(iii)(I)(2012 ed.) (requiring insurers to report 
whether eachinsurance plan they provided "is a qualified health 
planoffered through an Exchange established under [42

U. S. C. 18031]"). A Federal Exchange may therefore be considered one 
established "under [42 U. S. C. 18031]."
The upshot of all this is that the phrase "an Exchangeestablished by the 
State under [42 U. S. C. 18031]" isproperly viewed as ambiguous. The 
phrase may be limited in its reach to State Exchanges. But it is also 
possible that the phrase refers to all Exchanges-both State and

13 Cite as: 576 U. S. ____ (2015)

Opinion of the Court

Federal-at least for purposes of the tax credits. If a State chooses not 
to follow the directive in Section 18031 that it establish an Exchange, 
the Act tells the Secretary to establish "such Exchange." 18041. And by 
using thewords "such Exchange," the Act indicates that State and Federal 
Exchanges should be the same. But 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 more affordable 
by providing billions of dollars to the States' citizens; the other type 
of Exchange would not.2

The conclusion that Section 36B is ambiguous is furthersupported by 
several provisions that assume tax creditswill be available on both State 
and Federal Exchanges. For example, the Act requires all Exchanges to 
create outreach programs that must "distribute fair and impartial 
information concerning . . . the availability of premium tax credits under 
section 36B." 18031(i)(3)(B). The Act also requires all Exchanges to 
"establish and make avail- able by electronic means a calculator to 
determine theactual cost of coverage after the application of any premium 
tax credit under section 36B." 18031(d)(4)(G). And the Act requires all 
Exchanges to report to the Treasury Secretary information about each 
health plan they sell,

------ 2The dissent argues that the phrase "such Exchange" does not 
suggest that State and Federal Exchanges "are in all respects equivalent." 
Post, at 8. In support, it quotes the Constitution's Elections Clause, 
which makes the state legislature primarily responsible for 
prescribingelection regulations, but allows Congress to "make or alter 
such Regulations." Art. I, 4, cl. 1. No one would say that state and 
federalelection regulations are in all respects equivalent, the dissent 
contends,so we should not say that State and Federal Exchanges are. But 
the Elections Clause does not precisely define what an election regulation 
must look like, so Congress can prescribe regulations that differ fromwhat 
the State would prescribe. The Affordable Care Act does precisely define 
what an Exchange must look like, however, so a Federal Exchange cannot 
differ from a State Exchange.

14 KING v. BURWELL

Opinion of the Court

including the "aggregate amount of any advance payment of such credit," 
"[a]ny information . . . necessary to determine eligibility for, and the 
amount of, such credit," andany "[i]nformation necessary to determine 
whether a taxpayer has received excess advance payments." 26

U. S. C. 36B(f)(3). If tax credits were not available on Federal 
Exchanges, these provisions would make little sense.

Petitioners and the dissent respond that the words"established by the 
State" would be unnecessary if Congress meant to extend tax credits to 
both State and Fed- eral Exchanges. Brief for Petitioners 20; post, at 
4-5. But "our preference for avoiding surplusage constructions isnot 
absolute." Lamie v. United States Trustee, 540 U. S. 526, 536 (2004); see 
also Marx v. General Revenue Corp., 568 U. S. ___, ___ (2013) (slip op., 
at 13) ("The canon against surplusage is not an absolute rule"). And 
specifically with respect to this Act, rigorous application of thecanon 
does not seem a particularly useful guide to a fair construction of the 
statute.

The Affordable Care Act contains more than a few examples of inartful 
drafting. (To cite just one, the Actcreates three separate Section 1563s. 
See 124 Stat. 270, 911, 912.) Several features of the Act's passage 
contributed to that unfortunate reality. Congress wrote key parts of the 
Act behind closed doors, rather than through "the traditional legislative 
process." Cannan, A LegislativeHistory of the Affordable Care Act: How 
Legislative Procedure Shapes Legislative History, 105 L. Lib. J. 131, 
163(2013). And Congress passed much of the Act using a complicated 
budgetary procedure known as "reconciliation," which limited opportunities 
for debate and amendment, and bypassed the Senate's normal 60-vote 
filibuster requirement. Id., at 159-167. As a result, the Act does not 
reflect the type of care and deliberation that one mightexpect of such 
significant legislation. Cf. Frankfurter,

15 Cite as: 576 U. S. ____ (2015)

Opinion of the Court

Some Reflections on the Reading of Statutes, 47 Colum. L.Rev. 527, 545 
(1947) (describing a cartoon "in which asenator tells his colleagues 'I 
admit this new bill is toocomplicated to understand. We'll just have to 
pass it tofind out what it means.'").

Anyway, we "must do our best, bearing in mind thefundamental canon of 
statutory construction that thewords of a statute must be read in their 
context and with a view to their place in the overall statutory scheme." 
Util- ity Air Regulatory Group, 573 U. S., at ___ (slip op., at 15) 
(internal quotation marks omitted). After reading Section36B along with 
other related provisions in the Act, wecannot conclude that the phrase "an 
Exchange establishedby the State under [Section 18031]" is unambiguous.

B Given that the text is ambiguous, we must turn to thebroader structure 
of the Act to determine the meaning ofSection 36B. "A provision that may 
seem ambiguous inisolation is often clarified by the remainder of the 
statu- tory scheme . . . because only one of the permissible meanings 
produces a substantive effect that is compatible with the rest of the 
law." United Sav. Assn. of Tex. v. Timbers of Inwood Forest Associates, 
Ltd., 484 U. S. 365, 371 (1988). Here, the statutory scheme compels us to 
reject petitioners' interpretation because it would destabilize the 
individual insurance market in any State with a FederalExchange, and 
likely create the very "death spirals" thatCongress designed the Act to 
avoid. See New York State Dept. of Social Servs. v. Dublino, 413 U. S. 
405, 419-420 (1973) ("We cannot interpret federal statutes to negate their 
own stated purposes.").3 ------ 3The dissent notes that several other 
provisions in the Act use thephrase "established by the State," and argues 
that our holding appliesto each of those provisions. Post, at 5-6. But 
"the presumption ofconsistent usage readily yields to context," and a 
statutory term may

16 KING v. BURWELL

Opinion of the Court

As discussed above, Congress based the Affordable CareAct on three major 
reforms: first, the guaranteed issueand community rating requirements; 
second, a requirement that individuals maintain health insurance 
coverageor make a payment to the IRS; and third, the tax creditsfor 
individuals with household incomes between 100 percent and 400 percent of 
the federal poverty line. In a State that establishes its own Exchange, 
these threereforms work together to expand insurance coverage. The 
guaranteed issue and community rating requirementsensure that anyone can 
buy insurance; the coverage requirement creates an incentive for people to 
do so beforethey get sick; and the tax credits-it is hoped-make insurance 
more affordable. Together, those reforms "minimize . . . adverse selection 
and broaden the health in- surance risk pool to include healthy 
individuals, whichwill lower health insurance premiums." 42 U. S. C. 
18091(2)(I).

Under petitioners' reading, however, the Act wouldoperate quite 
differently in a State with a Federal Exchange. As they see it, one of the 
Act's three major reforms-the tax credits-would not apply. And a second 
major reform-the coverage requirement-would not apply in a meaningful way. 
As explained earlier, the coverage requirement applies only when the cost 
of buyinghealth insurance (minus the amount of the tax credits) isless 
than eight percent of an individual's income. 26

U. S. C. 5000A(e)(1)(A), (e)(1)(B)(ii). So without the tax credits, the 
coverage requirement would apply to fewer individuals. And it would be a 
lot fewer. In 2014, approx------
mean different things in different places. Utility Air Regulatory Group
v. EPA, 573 U. S. ___, ___ (2014) (slip op., at 15) (internal quotation 
marks omitted). That is particularly true when, as here, "the Act is far 
from a chef d'oeuvre of legislative draftsmanship." Ibid. Because the 
other provisions cited by the dissent are not at issue here, we do not 
address them.

17 Cite as: 576 U. S. ____ (2015)

Opinion of the Court

imately 87 percent of people who bought insurance on a Federal Exchange 
did so with tax credits, and virtually allof those people would become 
exempt. HHS, A. Burke, A. Misra, & S. Sheingold, Premium Affordability, 
Competition, and Choice in the Health Insurance Marketplace 5 (2014); 
Brief for Bipartisan Economic Scholars as Amici Curiae 19-20. If 
petitioners are right, therefore, only oneof the Act's three major reforms 
would apply in Stateswith a Federal Exchange.
The combination of no tax credits and an ineffective coverage requirement 
could well push a State's individualinsurance market into a death spiral. 
One study predictsthat premiums would increase by 47 percent and 
enrollment would decrease by 70 percent. E. Saltzman & C. Eibner, The 
Effect of Eliminating the Affordable CareAct's Tax Credits in Federally 
Facilitated Marketplaces (2015). Another study predicts that premiums 
would increase by 35 percent and enrollment would decrease by69 percent. 
L. Blumberg, M. Buettgens, & J. Holahan,The Implications of a Supreme 
Court Finding for thePlaintiff in King vs. Burwell: 8.2 Million More 
Uninsured and 35% Higher Premiums (2015). And those effects would not be 
limited to individuals who purchase insurance on the Exchanges. Because 
the Act requires insurersto treat the entire individual market as a single 
risk pool, 42 U. S. C. 18032(c)(1), premiums outside the Exchange would 
rise along with those inside the Exchange. Brief for Bipartisan Economic 
Scholars as Amici Curiae 11-12.

It is implausible that Congress meant the Act to operate in this manner. 
See National Federation of Independent Business v. Sebelius, 567 U. S. 
___, ___ (2012) (SCALIA, KENNEDY, THOMAS, and ALITO, JJ., dissenting) 
(slip op.,at 60) ("Without the federal subsidies . . . the exchangeswould 
not operate as Congress intended and may notoperate at all."). Congress 
made the guaranteed issue and community rating requirements applicable in 
every State

18 KING v. BURWELL

Opinion of the Court

in the Nation. But those requirements only work whencombined with the 
coverage requirement and the tax credits. So it stands to reason that 
Congress meant forthose provisions to apply in every State as well.4
Petitioners respond that Congress was not worriedabout the effects of 
withholding tax credits from Stateswith Federal Exchanges because 
"Congress evidentlybelieved it was offering states a deal they would not 
refuse." Brief for Petitioners 36. Congress may have beenwrong about the 
States' willingness to establish their own Exchanges, petitioners 
continue, but that does not allow this Court to rewrite the Act to fix 
that problem. That is particularly true, petitioners conclude, because the 
Stateslikely would have created their own Exchanges in the absence of the 
IRS Rule, which eliminated any incentivethat the States had to do so. Id., 
at 36-38.

Section 18041 refutes the argument that Congressbelieved it was offering 
the States a deal they would not -----

- 4The dissent argues that our analysis "show[s] only that the statutory 
scheme contains a flaw," one "that appeared as well in other partsof the 
Act." Post, at 14. For support, the dissent notes that the guaranteed 
issue and community rating requirements might apply in thefederal 
territories, even though the coverage requirement does not. Id., at 14-
15. The confusion arises from the fact that the guaranteed issueand 
community rating requirements were added as amendments to thePublic Health 
Service Act, which contains a definition of the word "State" that includes 
the territories, 42 U. S. C. 201(f), while the later-enacted Affordable 
Care Act contains a definition of the word "State" that excludes the 
territories, 18024(d). The predicate for the dissent's point is therefore 
uncertain at best. The dissent also notes that a different part of the Act 
"established along-term-care insurance program with guaranteed-issue and 
community-rating requirements, but without an individual mandate or 
subsidies." Post, at 14. True enough. But the fact that Congress was 
willing to accept the risk of adverse selection in a comparatively minor 
program does not show that Congress was willing to do so in the 
generalhealth insurance program-the very heart of the Act. Moreover, 
Congress said expressly that it wanted to avoid adverse selection in the 
health insurance markets. 18091(2)(I).

19 Cite as: 576 U. S. ____ (2015)

Opinion of the Court

refuse. That section provides that, if a State elects not toestablish an 
Exchange, the Secretary "shall . . . establishand operate such Exchange 
within the State." 42 U. S. C. 18041(c)(1)(A). The whole point of that 
provision is tocreate a federal fallback in case a State chooses not to 
establish its own Exchange. Contrary to petitioners' argument, Congress 
did not believe it was offering Statesa deal they would not refuse-it 
expressly addressed what would happen if a State did refuse the deal.

C Finally, the structure of Section 36B itself suggests thattax credits 
are not limited to State Exchanges. Section 36B(a) initially provides that 
tax credits "shall be allowed" for any "applicable taxpayer." Section 
36B(c)(1) then defines an "applicable taxpayer" as someone who (among 
other things) has a household income between 100 percent and 400 percent 
of the federal poverty line. Together,these two provisions appear to make 
anyone in the specified income range eligible to receive a tax 
credit.According to petitioners, however, those provisions are an empty 
promise in States with a Federal Exchange. In their view, an applicable 
taxpayer in such a State would be eligible for a tax credit-but the amount 
of that tax credit would always be zero. And that is because-diving 
several layers down into the Tax Code-Section 36B says that the amount of 
the tax credits shall be "an amount equal to the premium assistance credit 
amount," 36B(a);and then says that the term "premium assistance 
creditamount" means "the sum of the premium assistance amounts determined 
under paragraph (2) with respect to all coverage months of the taxpayer 
occurring during the taxable year," 36B(b)(1); and then says that the 
term"premium assistance amount" is tied to the amount of themonthly 
premium for insurance purchased on "an Exchange established by the State 
under [42 U. S. C.

20 KING v. BURWELL

Opinion of the Court

18031]," 36B(b)(2); and then says that the term "coverage month" means any 
month in which the taxpayer has insurance through "an Exchange established 
by the Stateunder [42 U. S. C. 18031]," 36B(c)(2)(A)(i).
We have held that Congress "does not alter the fundamental details of a 
regulatory scheme in vague terms orancillary provisions." Whitman v. 
American Trucking Assns., Inc., 531 U. S. 457, 468 (2001). But in 
petitioners'view, Congress made the viability of the entire AffordableCare 
Act turn on the ultimate ancillary provision: a sub-sub-sub section of the 
Tax Code. We doubt that is what Congress meant to do. Had Congress meant 
to limit tax credits to State Exchanges, it likely would have done so 
inthe definition of "applicable taxpayer" or in some other prominent 
manner. It would not have used such a winding path of connect-the-dots 
provisions about the amountof the credit.5
D Petitioners' arguments about the plain meaning ofSection 36B are strong. 
But while the meaning of thephrase "an Exchange established by the State 
under [42
U. S. C. 18031]" may seem plain "when viewed in isolation," such a reading 
turns out to be "untenable in light of[the statute] as a whole." 
Department of Revenue of Ore. v. ACF Industries, Inc., 510 U. S. 332, 343 
(1994). In this instance, the context and structure of the Act compel us 
todepart from what would otherwise be the most natural reading of the 
pertinent statutory phrase.

------ 5The dissent cites several provisions that "make[ ] taxpayers of 
allStates eligible for a credit, only to provide later that the amount of 
the credit may be zero." Post, at 11 (citing 26 U. S. C. 24, 32, 35, 36). 
None of those provisions, however, is crucial to the viability of a 
comprehensive program like the Affordable Care Act. No one suggests, 
forexample, that the first-time-homebuyer tax credit, 36, is essential to 
the viability of federal housing regulation.

21 Cite as: 576 U. S. ____ (2015)

Opinion of the Court

Reliance on context and structure in statutory interpretation is a "subtle 
business, calling for great wariness lest what professes to be mere 
rendering becomes creation and attempted interpretation of legislation 
becomes legislation itself." Palmer v. Massachusetts, 308 U. S. 79, 83 
(1939).For the reasons we have given, however, such reliance isappropriate 
in this case, and leads us to conclude that Section 36B allows tax credits 
for insurance purchased onany Exchange created under the Act. Those 
credits are necessary for the Federal Exchanges to function like 
theirState Exchange counterparts, and to avoid the type of calamitous 
result that Congress plainly meant to avoid.
* * * In a democracy, the power to make the law rests withthose chosen by 
the people. Our role is more confined-"to say what the law is." Marbury v. 
Madison, 1 Cranch 137, 177 (1803). That is easier in some cases than in 
others. But in every case we must respect the role of the Legislature, and 
take care not to undo what it has done. A fair reading of legislation 
demands a fair understanding of thelegislative plan.Congress passed the 
Affordable Care Act to improvehealth insurance markets, not to destroy 
them. If at all possible, we must interpret the Act in a way that is 
consistent with the former, and avoids the latter. Section 36B can fairly 
be read consistent with what we see as Congress's plan, and that is the 
reading we adopt.The judgment of the United States Court of Appeals for 
the Fourth Circuit is Affirmed.


_________________
_________________


Cite as: 576 U. S. ____ (2015) 1
SCALIA, J., dissenting
SUPREME COURT OF THE UNITED STATES
No. 14-114
DAVID KING, ET AL., PETITIONERS v. SYLVIA
BURWELL, SECRETARY OF HEALTH
AND HUMAN SERVICES, ET AL.
ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE FOURTH CIRCUIT
[June 25, 2015]

JUSTICE SCALIA, with whom JUSTICE THOMAS and JUSTICE ALITO join, 
dissenting.
The Court holds that when the Patient Protection and Affordable Care Act 
says "Exchange established by theState" it means "Exchange established by 
the State or theFederal Government." That is of course quite absurd, and 
the Court's 21 pages of explanation make it no less so.
I The Patient Protection and Affordable Care Act makes major reforms to 
the American health-insurance market.It provides, among other things, that 
every State "shall . . .establish an American Health Benefit Exchange"-a 
marketplace where people can shop for health-insurance plans. 42 U. S. C. 
18031(b)(1). And it provides that if aState does not comply with this 
instruction, the Secretaryof Health and Human Services must "establish and 
operate such Exchange within the State." 18041(c)(1). A separate part of 
the Act-housed in 36B of the Internal Revenue Code-grants "premium tax 
credits" to subsidize certain purchases of health insurance made on 
Exchanges. The tax credit consists of "premium assistanceamounts" for 
"coverage months." 26 U. S. C. 36B(b)(1). An individual has a coverage 
month only when he is cov2

KING v. BURWELL

SCALIA, J., dissenting
ered by an insurance plan "that was enrolled in through an Exchange 
established by the State under [18031]." 36B(c)(2)(A). And the law ties 
the size of the premiumassistance amount to the premiums for health plans 
whichcover the individual "and which were enrolled in throughan Exchange 
established by the State under [18031]." 36B(b)(2)(A). The premium 
assistance amount further depends on the cost of certain other insurance 
plans "offered through the same Exchange." 36B(b)(3)(B)(i).

This case requires us to decide whether someone who buys insurance on an 
Exchange established by the Secretary gets tax credits. You would think 
the answer would be obvious-so obvious there would hardly be a need for 
the Supreme Court to hear a case about it. In order to receive any money 
under 36B, an individual must enrollin an insurance plan through an 
"Exchange established by the State." The Secretary of Health and Human 
Services is not a State. So an Exchange established by the Secretary is 
not an Exchange established by the State-whichmeans people who buy health 
insurance through such anExchange get no money under 36B.
Words no longer have meaning if an Exchange that is not established by a 
State is "established by the State." It is hard to come up with a clearer 
way to limit tax credits to state Exchanges than to use the words 
"established by the State." And it is hard to come up with a reason to 
include the words "by the State" other than the purpose of limiting 
credits to state Exchanges. "[T]he plain, obvious, and rational meaning of 
a statute is always to be preferred to any curious, narrow, hidden sense 
that nothing but the exigency of a hard case and the ingenuity and study 
of anacute and powerful intellect would discover." Lynch v. 
Alworth-Stephens Co., 267 U. S. 364, 370 (1925) (internalquotation marks 
omitted). Under all the usual rules of interpretation, in short, the 
Government should lose this case. But normal rules of interpretation seem 
always to

Cite as: 576 U. S. ____ (2015) 3
SCALIA, J., dissenting

yield to the overriding principle of the present Court: The Affordable 
Care Act must be saved.
II The Court interprets 36B to award tax credits on both federal and state 
Exchanges. It accepts that the "most natural sense" of the phrase 
"Exchange established by theState" is an Exchange established by a State. 
Ante, at 11. (Understatement, thy name is an opinion on the Afford- able 
Care Act!) Yet the opinion continues, with no semblance of shame, that "it 
is also possible that the phrase refers to all Exchanges-both State and 
Federal." Ante, at
13. (Impossible possibility, thy name is an opinion on the Affordable Care 
Act!) The Court claims that "the context and structure of the Act compel 
[it] to depart from whatwould otherwise be the most natural reading of the 
pertinent statutory phrase." Ante, at 21.

I wholeheartedly agree with the Court that sound interpretation requires 
paying attention to the whole law, not homing in on isolated words or even 
isolated sections. Context always matters. Let us not forget, however, 
whycontext matters: It is a tool for understanding the terms ofthe law, 
not an excuse for rewriting them.
Any effort to understand rather than to rewrite a lawmust accept and apply 
the presumption that lawmakers use words in "their natural and ordinary 
signification." Pensacola Telegraph Co. v. Western Union Telegraph Co., 96 
U. S. 1, 12 (1878). Ordinary connotation does notalways prevail, but the 
more unnatural the proposed interpretation of a law, the more compelling 
the contex- tual evidence must be to show that it is correct. 
Today'sinterpretation is not merely unnatural; it is unheard of.Who would 
ever have dreamt that "Exchange established by the State" means "Exchange 
established by the State or the Federal Government"? Little short of an 
express statutory definition could justify adopting this singular reading.

4 KING v. BURWELL

SCALIA, J., dissenting

Yet the only pertinent definition here provides that "State"means "each of 
the 50 States and the District of Columbia." 42 U. S. C. 18024(d). Because 
the Secretary isneither one of the 50 States nor the District of Columbia, 
that definition positively contradicts the eccentric theory that an 
Exchange established by the Secretary has been established by the State.

Far from offering the overwhelming evidence of meaningneeded to justify 
the Court's interpretation, other contextual clues undermine it at every 
turn. To begin with,other parts of the Act sharply distinguish between the 
establishment of an Exchange by a State and the establishment of an 
Exchange by the Federal Government. The States' authority to set up 
Exchanges comes from oneprovision, 18031(b); the Secretary's authority 
comes froman entirely different provision, 18041(c). Funding forStates to 
establish Exchanges comes from one part of thelaw, 18031(a); funding for 
the Secretary to establishExchanges comes from an entirely different part 
of thelaw, 18121. States generally run state-created Exchanges; the 
Secretary generally runs federally created Exchanges. 18041(b)-(c). And 
the Secretary's authority to set up an Exchange in a State depends upon 
the State's"[f]ailure to establish [an] Exchange." 18041(c) (emphasis 
added). Provisions such as these destroy any pretensethat a federal 
Exchange is in some sense also established by a State.

Reading the rest of the Act also confirms that, as relevant here, there 
are only two ways to set up an Exchangein a State: establishment by a 
State and establishment bythe Secretary. 18031(b), 18041(c). So saying 
that anExchange established by the Federal Government is "established by 
the State" goes beyond giving words bizarremeanings; it leaves the 
limiting phrase "by the State" withno operative effect at all. That is a 
stark violation of the elementary principle that requires an interpreter 
"to give

Cite as: 576 U. S. ____ (2015) 5

SCALIA, J., dissenting

effect, if possible, to every clause and word of a statute." Montclair v. 
Ramsdell, 107 U. S. 147, 152 (1883). In weighing this argument, it is well 
to remember the difference between giving a term a meaning that 
duplicatesanother part of the law, and giving a term no meaning atall. 
Lawmakers sometimes repeat themselves-whetherout of a desire to add 
emphasis, a sense of belt-andsuspenders caution, or a lawyerly penchant 
for doublets (aid and abet, cease and desist, null and void). Lawmakers do 
not, however, tend to use terms that "have no operation at all." Marbury 
v. Madison, 1 Cranch 137, 174 (1803). So while the rule against treating a 
term as a redundancy is far from categorical, the rule against treating it 
as a nullity is as close to absolute as interpretiveprinciples get. The 
Court's reading does not merely give "by the State" a duplicative effect; 
it causes the phrase to have no effect whatever.

Making matters worse, the reader of the whole Act willcome across a number 
of provisions beyond 36B that referto the establishment of Exchanges by 
States. Adoptingthe Court's interpretation means nullifying the term "by 
the State" not just once, but again and again throughoutthe Act. Consider 
for the moment only those parts of the Act that mention an "Exchange 
established by the State" in connection with tax credits:

? The formula for calculating the amount of the taxcredit, as already 
explained, twice mentions "an Exchange established by the State." 26 U. S. 
C. 36B(b)(2)(A), (c)(2)(A)(i).

? The Act directs States to screen children for eligibility for "[tax 
credits] under section 36B" and for "anyother assistance or subsidies 
available for coverage obtained through" an "Exchange established by 
theState." 42 U. S. C. 1396w-3(b)(1)(B)-(C).

? The Act requires "an Exchange established by the
6 KING v. BURWELL
SCALIA, J., dissenting
State" to use a "secure electronic interface" to determine eligibility for 
(among other things) tax credits. 1396w-3(b)(1)(D).

? The Act authorizes "an Exchange established by the State" to make 
arrangements under which other stateagencies "determine whether a State 
resident is eligible for [tax credits] under section 36B." 1396w-3(b)(2).

? The Act directs States to operate Web sites that allow anyone "who is 
eligible to receive [tax credits] under section 36B" to compare insurance 
plans offered through "an Exchange established by the State." 
1396w-3(b)(4).

? One of the Act's provisions addresses the enrollmentof certain children 
in health plans "offered through anExchange established by the State" and 
then dis- cusses the eligibility of these children for tax credits. 
1397ee(d)(3)(B).

It is bad enough for a court to cross out "by the State" once. But seven 
times?
Congress did not, by the way, repeat "Exchange established by the State 
under [18031]" by rote throughout theAct. Quite the contrary, clause after 
clause of the law usesa more general term such as "Exchange" or 
"Exchangeestablished under [18031]." See, e.g., 42 U. S. C. 18031(k), 
18033; 26 U. S. C. 6055. It is common sense that any speaker who says 
"Exchange" some of the time, but "Exchange established by the State" the 
rest of the time, probably means something by the contrast.

Equating establishment "by the State" with establishment by the Federal 
Government makes nonsense of other parts of the Act. The Act requires 
States to ensure (on pain of losing Medicaid funding) that any 
"Exchangeestablished by the State" uses a "secure electronic interCite
as: 576 U. S. ____ (2015) 7

SCALIA, J., dissenting

face" to determine an individual's eligibility for variousbenefits 
(including tax credits). 42 U. S. C. 1396w- 3(b)(1)(D). How could a State 
control the type of electronic interface used by a federal Exchange? The 
Act allows a State to control contracting decisions made by "an Exchange 
established by the State." 18031(f)(3). Whywould a State get to control 
the contracting decisions of a federal Exchange? The Act also provides 
"Assistance toStates to establish American Health Benefit Exchanges" and 
directs the Secretary to renew this funding "if theState . . . is making 
progress . . . toward . . . establishingan Exchange." 18031(a). Does a 
State that refuses to set up an Exchange still receive this funding, on 
the premisethat Exchanges established by the Federal Government are really 
established by States? It is presumably in orderto avoid these questions 
that the Court concludes that federal Exchanges count as state Exchanges 
only "forpurposes of the tax credits." Ante, at 13. (Contrivance,thy name 
is an opinion on the Affordable Care Act!)

It is probably piling on to add that the Congress that wrote the 
Affordable Care Act knew how to equate two different types of Exchanges 
when it wanted to do so. The Act includes a clause providing that "[a] 
territory that . . . establishes . . . an Exchange . . . shall be treated 
as a State" for certain purposes. 18043(a) (emphasis added).Tellingly, it 
does not include a comparable clause providing that the Secretary shall be 
treated as a State for purposes of 36B when she establishes an Exchange.

Faced with overwhelming confirmation that "Exchangeestablished by the 
State" means what it looks like it means, the Court comes up with argument 
after feeble argument to support its contrary interpretation. None of its 
tries comes close to establishing the implausible conclusion that Congress 
used "by the State" to mean "by the State or not by the State."

The Court emphasizes that if a State does not set up an

8 KING v. BURWELL

SCALIA, J., dissenting

Exchange, the Secretary must establish "such Exchange." 18041(c). It 
claims that the word "such" implies that federal and state Exchanges are 
"the same." Ante, at 13. To see the error in this reasoning, one need only 
consider a parallel provision from our Constitution: "The Times, Places 
and Manner of holding Elections for Senators and Representatives, shall be 
prescribed in each State by the Legislature thereof; but the Congress may 
at any time byLaw make or alter such Regulations." Art. I, 4, cl. 1 
(emphasis added). Just as the Affordable Care Act directs States to 
establish Exchanges while allowing the Secretary to establish "such 
Exchange" as a fallback, the Elections Clause directs state legislatures 
to prescribe electionregulations while allowing Congress to make "such 
Regulations" as a fallback. Would anybody refer to an electionregulation 
made by Congress as a "regulation prescribed by the state legislature"? 
Would anybody say that a federal election law and a state election law are 
in all respects equivalent? Of course not. The word "such" does not help 
the Court one whit. The Court's argument also overlooks the rudimentary 
principle that a specific provision governs a general one. Even if it were 
true that the term "such Exchange" in 18041(c) implies that federaland 
state Exchanges are the same in general, the term"established by the 
State" in 36B makes plain that they differ when it comes to tax credits in 
particular.

The Court's next bit of interpretive jiggery-pokery involves other parts 
of the Act that purportedly presuppose the availability of tax credits on 
both federal and state Exchanges. Ante, at 13-14. It is curious that the 
Court is willing to subordinate the express words of the sectionthat 
grants tax credits to the mere implications of other provisions with only 
tangential connections to tax credits.One would think that interpretation 
would work the otherway around. In any event, each of the provisions 
mentioned by the Court is perfectly consistent with limiting

Cite as: 576 U. S. ____ (2015) 9

SCALIA, J., dissenting

tax credits to state Exchanges. One of them says that theminimum functions 
of an Exchange include (alongside several tasks that have nothing to do 
with tax credits) setting up an electronic calculator that shows "the 
actualcost of coverage after the application of any premium taxcredit." 42 
U. S. C. 18031(d)(4)(G). What stops a federal Exchange's electronic 
calculator from telling a customer that his tax credit is zero? Another 
provision requires an Exchange's outreach program to educate the public 
about health plans, to facilitate enrollment, and to "distributefair and 
impartial information" about enrollment and "theavailability of premium 
tax credits." 18031(i)(3)(B).What stops a federal Exchange's outreach 
program fromfairly and impartially telling customers that no tax 
creditsare available? A third provision requires an Exchange to report 
information about each insurance plan sold-including level of coverage, 
premium, name of the insured,and "amount of any advance payment" of the 
tax credit.26 U. S. C. 36B(f)(3). What stops a federal Exchange'sreport 
from confirming that no tax credits have been paidout?

The Court persists that these provisions "would makelittle sense" if no 
tax credits were available on federal Exchanges.

Ante, at 14. Even if that observation were true, it would show only 
oddity, not ambiguity. Laws often include unusual or mismatched 
provisions. The Affordable Care Act spans 900 pages; it would be amazingif 
its provisions all lined up perfectly with each other.This Court "does not 
revise legislation . . . just because the text as written creates an 
apparent anomaly." Michigan v. Bay Mills Indian Community, 572 U. S. ___, 
___ (2014) (slip op., at 10). At any rate, the provisions cited by the 
Court are not particularly unusual. Each requires an Exchange to perform a 
standardized series of tasks, someaspects of which relate in some way to 
tax credits. It is entirely natural for slight mismatches to occur when, 
as

10 KING v. BURWELL

SCALIA, J., dissenting

here, lawmakers draft "a single statutory provision" tocover "different 
kinds" of situations. Robers v. United States, 572 U. S. ___, ___ (2014) 
(slip op., at 4). Lawmakers need not, and often do not, "write extra 
languagespecifically exempting, phrase by phrase, applications inrespect 
to which a portion of a phrase is not needed." Ibid.
Roaming even farther afield from 36B, the Court turns to the Act's 
provisions about "qualified individuals." Ante, at 10-11. Qualified 
individuals receive favored treatment on Exchanges, although customers who 
are not qualified individuals may also shop there. See Halbig v. Burwell, 
758 F. 3d 390, 404-405 (CADC 2014). The Court claims that the Act must 
equate federal and state establishment of Exchanges when it defines a 
qualified individual assomeone who (among other things) lives in the 
"State that established the Exchange," 42 U. S. C. 
18032(f)(1)(A).Otherwise, the Court says, there would be no 
qualifiedindividuals on federal Exchanges, contradicting (for example) the 
provision requiring every Exchange to take the "'interests of qualified 
individuals'" into accountwhen selecting health plans. Ante, at 11 
(quoting18031(e)(1)(b)). Pure applesauce. Imagine that a university sends 
around a bulletin reminding every professor to take the "interests of 
graduate students" into accountwhen setting office hours, but that some 
professors teachonly undergraduates. Would anybody reason that the 
bulletin implicitly presupposes that every professor has"graduate 
students," so that "graduate students" mustreally mean "graduate or 
undergraduate students"? Surely not. Just as one naturally reads 
instructions aboutgraduate students to be inapplicable to the extent a 
particular professor has no such students, so too would onenaturally read 
instructions about qualified individuals tobe inapplicable to the extent a 
particular Exchange has nosuch individuals. There is no need to rewrite 
the term "State that established the Exchange" in the definition of

11 Cite as: 576 U. S. ____ (2015)

SCALIA, J., dissenting

"qualified individual," much less a need to rewrite theseparate term 
"Exchange established by the State" in aseparate part of the Act.

Least convincing of all, however, is the Court's attemptto uncover support 
for its interpretation in "the structureof Section 36B itself." Ante, at 
19. The Court finds it strange that Congress limited the tax credit to 
state Exchanges in the formula for calculating the amount of the credit, 
rather than in the provision defining the range of taxpayers eligible for 
the credit. Had the Court bothered to look at the rest of the Tax Code, it 
would have seen that the structure it finds strange is in fact quite 
common. Consider, for example, the many provisions that initially make 
taxpayers of all incomes eligible for a tax credit, onlyto provide later 
that the amount of the credit is zero if the taxpayer's income exceeds a 
specified threshold. See, e.g., 26 U. S. C. 24 (child tax credit); 32 
(earned-income tax credit); 36 (first-time-homebuyer tax credit). Or 
consider, for an even closer parallel, a neighboring provision 
thatinitially makes taxpayers of all States eligible for a credit, only to 
provide later that the amount of the credit may bezero if the taxpayer's 
State does not satisfy certain requirements. See 35 
(health-insurance-costs tax credit).One begins to get the sense that the 
Court's insistence onreading things in context applies to "established by 
theState," but to nothing else.
For what it is worth, lawmakers usually draft tax-credit provisions the 
way they do-i.e., the way they drafted 36B-because the mechanics of the 
credit require it. Many Americans move to new States in the middle of the 
year. Mentioning state Exchanges in the definition of "coverage 
month"-rather than (as the Court proposes) inthe provisions concerning 
taxpayers' eligibility for the credit-accounts for taxpayers who live in a 
State with astate Exchange for a part of the year, but a State with 
afederal Exchange for the rest of the year. In addition,

12 KING v. BURWELL

SCALIA, J., dissenting

36B awards a credit with respect to insurance plans "which cover the 
taxpayer, the taxpayer's spouse, or any dependent . . . of the taxpayer 
and which were enrolled in through an Exchange established by the State." 
36B(b)(2)(A) (emphasis added). If Congress had mentioned state Exchanges 
in the provisions discussing taxpayers' eligibility for the credit, a 
taxpayer who buysinsurance from a federal Exchange would get no money,even 
if he has a spouse or dependent who buys insurance from a state 
Exchange-say a child attending college in a different State. It thus makes 
perfect sense for "Exchangeestablished by the State" to appear where it 
does, rather than where the Court suggests. Even if that were not so, of 
course, its location would not make it any less clear.
The Court has not come close to presenting the compelling contextual case 
necessary to justify departing fromthe ordinary meaning of the terms of 
the law. Quite the contrary, context only underscores the outlandishness 
ofthe Court's interpretation. Reading the Act as a wholeleaves no doubt 
about the matter: "Exchange established by the State" means what it looks 
like it means.

III For its next defense of the indefensible, the Court turns to the 
Affordable Care Act's design and purposes. As relevant here, the Act makes 
three major reforms. The guaranteed-issue and community-rating 
requirementsprohibit insurers from considering a customer's health when 
deciding whether to sell insurance and how much tocharge, 42 U. S. C. 
300gg, 300gg-1; its famous individ- ual mandate requires everyone to 
maintain insurancecoverage or to pay what the Act calls a "penalty," 26 U. 
S. C. 5000A(b)(1), and what we have nonetheless called a tax, see National 
Federation of Independent Business v. Sebelius, 567 U. S. ___, ___ (2012) 
(slip op., at 39); and its tax credits help make insurance more 
affordable.

13 Cite as: 576 U. S. ____ (2015)

SCALIA, J., dissenting

The Court reasons that Congress intended these three reforms to "work 
together to expand insurance coverage";and because the first two apply in 
every State, so must the third. Ante, at 16.

This reasoning suffers from no shortage of flaws. To begin with, "even the 
most formidable argument concerning the statute's purposes could not 
overcome the clarity[of] the statute's text." Kloeckner v. Solis, 568 U. 
S. ___, ___, n. 4 (2012) (slip op., at 14, n. 4). Statutory design 
andpurpose matter only to the extent they help clarify anotherwise 
ambiguous provision. Could anyone maintainwith a straight face that 36B is 
unclear? To mention justthe highlights, the Court's interpretation clashes 
with a statutory definition, renders words inoperative in at least seven 
separate provisions of the Act, overlooks the contrast between provisions 
that say "Exchange" and thosethat say "Exchange established by the State," 
gives the same phrase one meaning for purposes of tax credits butan 
entirely different meaning for other purposes, and (let us not forget) 
contradicts the ordinary meaning of the words Congress used. On the other 
side of the ledger, theCourt has come up with nothing more than a general 
provision that turns out to be controlled by a specific one,a handful of 
clauses that are consistent with either understanding of establishment by 
the State, and a resemblance between the tax-credit provision and the rest 
of the TaxCode. If that is all it takes to make something 
ambiguous,everything is ambiguous.

Having gone wrong in consulting statutory purpose atall, the Court goes 
wrong again in analyzing it. The purposes of a law must be "collected 
chiefly from its words,"not "from extrinsic circumstances." Sturges v. 
Crowninshield, 4 Wheat. 122, 202 (1819) (Marshall, C. J.). Onlyby 
concentrating on the law's terms can a judge hope touncover the scheme of 
the statute, rather than some other scheme that the judge thinks 
desirable. Like it or not, the

14 KING v. BURWELL

SCALIA, J., dissenting

express terms of the Affordable Care Act make only two ofthe three reforms 
mentioned by the Court applicable inStates that do not establish 
Exchanges. It is perfectly possible for them to operate independently of 
tax credits. The guaranteed-issue and community-rating requirements 
continue to ensure that insurance companies treat all customers the same 
no matter their health, and the individual mandate continues to encourage 
people to maintaincoverage, lest they be "taxed."

The Court protests that without the tax credits, thenumber of people 
covered by the individual mandateshrinks, and without a broadly applicable 
individual mandate the guaranteed-issue and community-rating requirements 
"would destabilize the individual insurance market." Ante, at 15. If true, 
these projections would show only that the statutory scheme contains a 
flaw; they would not show that the statute means the opposite of what it 
says. Moreover, it is a flaw that appeared as well in other parts of the 
Act. A different title established a long-term-care insurance program with 
guaranteed-issue and community-rating requirements, but without an 
individual mandate or subsidies. 8001-8002, 124 Stat. 828-847 (2010). This 
program never came into effect "only because Congress, in response to 
actuarial analyses predicting that the [program] would be fiscally 
unsustainable,repealed the provision in 2013." Halbig, 758 F. 3d, at 410. 
How could the Court say that Congress would never dream of combining 
guaranteed-issue and community-rating requirements with a narrow 
individual mandate,when it combined those requirements with no individual 
mandate in the context of long-term-care insurance?

Similarly, the Department of Health and Human Services originally 
interpreted the Act to impose guaranteed-issue and community-rating 
requirements in the FederalTerritories, even though the Act plainly does 
not make the individual mandate applicable there. Ibid.; see 26 U. S. C.

Cite as: 576 U. S. ____ (2015) 15

SCALIA, J., dissenting

5000A(f)(4); 42 U. S. C. 201(f). "This combination, predictably, [threw] 
individual insurance markets in the territories into turmoil." Halbig, 
supra, at 410. Responding to complaints from the Territories, the 
Department atfirst insisted that it had "no statutory authority" to 
address the problem and suggested that the Territories "seek legislative 
relief from Congress" instead. Letter from G. Cohen, Director of the 
Center for Consumer Information and Insurance Oversight, to S. Igisomar, 
Secretary of Commerce of the Commonwealth of Northern Mariana Islands 
(July 12, 2013). The Department changed its mind a year later, after what 
it described as "a careful review of [the] situation and the relevant 
statutory language." Letter from M. Tavenner, Administrator of the Centers 
for Medicare and Medicaid Services, to G. Francis, Insurance Commissioner 
of the Virgin Islands (July 16, 2014). How could the Court pronounce it 
"implausible" for Congress to have tolerated instability in insurance 
markets in States with federal Exchanges, ante, at 17, when even the 
Government maintained until recently thatCongress did exactly that in 
American Samoa, Guam, theNorthern Mariana Islands, Puerto Rico, and the 
VirginIslands?

Compounding its errors, the Court forgets that it is no more appropriate 
to consider one of a statute's purposes in isolation than it is to 
consider one of its words that way.No law pursues just one purpose at all 
costs, and no statutory scheme encompasses just one element. Most relevant 
here, the Affordable Care Act displays a congressionalpreference for state 
participation in the establishment ofExchanges: Each State gets the first 
opportunity to set upits Exchange, 42 U. S. C. 18031(b); States that take 
upthe opportunity receive federal funding for "activities . . .related to 
establishing" an Exchange, 18031(a)(3); and the Secretary may establish an 
Exchange in a State only as a fallback, 18041(c). But setting up and 
running an

16 KING v. BURWELL

SCALIA, J., dissenting

Exchange involve significant burdens-meeting strict deadlines, 18041(b), 
implementing requirements related to the offering of insurance plans, 
18031(d)(4), setting upoutreach programs, 18031(i), and ensuring that 
theExchange is self-sustaining by 2015, 18031(d)(5)(A). A State would have 
much less reason to take on these burdens if its citizens could receive 
tax credits no matter who establishes its Exchange. (Now that the Internal 
Revenue Service has interpreted 36B to authorize tax credits everywhere, 
by the way, 34 States have failed to set up their own Exchanges. Ante, at 
6.) So even if makingcredits available on all Exchanges advances the goal 
of improving healthcare markets, it frustrates the goal of encouraging 
state involvement in the implementation of the Act. This is what justifies 
going out of our way to read"established by the State" to mean 
"established by the State or not established by the State"?

Worst of all for the repute of today's decision, the Court's reasoning is 
largely self-defeating. The Court predicts that making tax credits 
unavailable in States thatdo not set up their own Exchanges would cause 
disastrouseconomic consequences there. If that is so, however, wouldn't 
one expect States to react by setting up their ownExchanges? And wouldn't 
that outcome satisfy two of the Act's goals rather than just one: enabling 
the Act's reformsto work and promoting state involvement in the Act's 
implementation? The Court protests that the very existence of a federal 
fallback shows that Congress expected that some States might fail to set 
up their own Exchanges. Ante, at 19. So it does. It does not show, 
however, that Congress expected the number of recalcitrant States to 
beparticularly large. The more accurate the Court's dire economic 
predictions, the smaller that number is likely tobe. That reality destroys 
the
Court's pretense that applying the law as written would imperil "the 
viability of theentire Affordable Care Act." Ante, at
20. All in all, the

17 Cite as: 576 U. S. ____ (2015)
SCALIA, J., dissenting

Court's arguments about the law's purpose and design areno more convincing 
than its arguments about context.
IV Perhaps sensing the dismal failure of its efforts to show that 
"established by the State" means "established by theState or the Federal 
Government," the Court tries to palm off the pertinent statutory phrase as 
"inartful drafting." Ante, at 14. This Court, however, has no 
free-floatingpower "to rescue Congress from its drafting errors." Lamie v. 
United States Trustee, 540 U. S. 526, 542 (2004) (internal quotation marks 
omitted). Only when it is patently obvious to a reasonable reader that a 
drafting mistake has occurred may a court correct the mistake. The 
occurrence of a misprint may be apparent from the face ofthe law, as it is 
where the Affordable Care Act "creates three separate Section 1563s." 
Ante, at 14. But the Court does not pretend that there is any such 
indication of a drafting error on the face of 36B. The occurrence of a 
misprint may also be apparent because a provision decrees an absurd 
result-a consequence "so monstrous, that allmankind would, without 
hesitation, unite in rejecting the application." Sturges, 4 Wheat., at 
203. But 36B does not come remotely close to satisfying that 
demandingstandard. It is entirely plausible that tax credits 
wererestricted to state Exchanges deliberately-for example, in order to 
encourage States to establish their own Exchanges. We therefore have no 
authority to dismiss theterms of the law as a drafting fumble.Let us not 
forget that the term "Exchange established by the State" appears twice in 
36B and five more times in other parts of the Act that mention tax 
credits. What are the odds, do you think, that the same slip of the pen 
occurred in seven separate places? No provision of the Act-none at 
all-contradicts the limitation of tax credits to state Exchanges. And as I 
have already explained, uses of

18 KING v. BURWELL

SCALIA, J., dissenting

the term "Exchange established by the State" beyond the context of tax 
credits look anything but accidental. Supra,at 6. If there was a mistake 
here, context suggests it was a substantive mistake in designing this part 
of the law, not a technical mistake in transcribing it.

V The Court's decision reflects the philosophy that judgesshould endure 
whatever interpretive distortions it takes inorder to correct a supposed 
flaw in the statutory machinery. That philosophy ignores the American 
people's decision to give Congress "[a]ll legislative Powers" enumerated 
in the Constitution. Art. I, 1. They made Congress, notthis Court, 
responsible for both making laws and mendingthem. This Court holds only 
the judicial power-the power to pronounce the law as Congress has enacted 
it. We lack the prerogative to repair laws that do not work out in 
practice, just as the people lack the ability to throwus out of office if 
they dislike the solutions we concoct. We must always remember, therefore, 
that "[o]ur task is toapply the text, not to improve upon it." Pavelic & 
LeFlore
v. Marvel Entertainment Group, Div. of Cadence Industries Corp., 493 U. S. 
120, 126 (1989).

Trying to make its judge-empowering approach seem respectful of 
congressional authority, the Court asserts that its decision merely 
ensures that the Affordable Care Act operates the way Congress "meant [it] 
to operate." Ante, at 17. First of all, what makes the Court so sure that 
Congress "meant" tax credits to be available everywhere? Our only evidence 
of what Congress meant comesfrom the terms of the law, and those terms 
show beyondall question that tax credits are available only on 
stateExchanges. More importantly, the Court forgets that oursis a 
government of laws and not of men. That means we are governed by the terms 
of our laws, not by the unenacted will of our lawmakers. "If Congress 
enacted into law

Cite as: 576 U. S. ____ (2015) 19

SCALIA, J., dissenting

something different from what it intended, then it should amend the 
statute to conform to its intent." Lamie, supra, at 542. In the meantime, 
this Court "has no roving license. . . to disregard clear language simply 
on the view that . . . Congress 'must have intended' something broader." 
Bay Mills, 572 U. S., at ___ (slip op., at 11).

Even less defensible, if possible, is the Court's claim that its 
interpretive approach is justified because this Act"does not reflect the 
type of care and deliberation that onemight expect of such significant 
legislation." Ante, at 14-
15. It is not our place to judge the quality of the care and deliberation 
that went into this or any other law. A law enacted by voice vote with no 
deliberation whatever isfully as binding upon us as one enacted after 
years ofstudy, months of committee hearings, and weeks of debate. Much 
less is it our place to make everything comeout right when Congress does 
not do its job properly. It is up to Congress to design its laws with 
care, and it is up tothe people to hold them to account if they fail to 
carry outthat responsibility.

Rather than rewriting the law under the pretense of interpreting it, the 
Court should have left it to Congress todecide what to do about the Act's 
limitation of tax credits to state Exchanges. If Congress values above 
everythingelse the Act's applicability across the country, it could make 
tax credits available in every Exchange. If it prizesstate involvement in 
the Act's implementation, it could continue to limit tax credits to state 
Exchanges while taking other steps to mitigate the economic consequences 
predicted by the Court. If Congress wants to accommodate both goals, it 
could make tax credits available everywhere while offering new incentives 
for States to set up their own Exchanges. And if Congress thinks that the 
present design of the Act works well enough, it could do nothing. Congress 
could also do something else alto- gether, entirely abandoning the 
structure of the Affordable

20 KING v. BURWELL

SCALIA, J., dissenting

Care Act. The Court's insistence on making a choice thatshould be made by 
Congress both aggrandizes judicial power and encourages congressional 
lassitude.

Just ponder the significance of the Court's decision totake matters into 
its own hands. The Court's revision of the law authorizes the Internal 
Revenue Service to spend tens of billions of dollars every year in tax 
credits on federal Exchanges. It affects the price of insurance for 
millions of Americans. It diminishes the participation of the States in 
the implementation of the Act. It vastly expandsthe reach of the Act's 
individual mandate, whose scopedepends in part on the availability of 
credits. What a parody today's decision makes of Hamilton's assurances to 
the people of New York: "The legislature not only commands the purse but 
prescribes the rules by which the duties and rights of every citizen are 
to be regulated. The judiciary, on the contrary, has no influence over . . 
. the purse; no direction . . . of the wealth of society, and cantake no 
active resolution whatever. It may truly be said to have neither FORCE nor 
WILL but merely judgment." The Federalist No. 78, p. 465 (C. Rossiter ed. 
1961).

* * * Today's opinion changes the usual rules of statutory interpretation 
for the sake of the Affordable Care Act.That, alas, is not a novelty. In 
National Federation of Independent Business v. Sebelius, 567 U. S. ___, 
this Court revised major components of the statute in order to save them 
from unconstitutionality. The Act that Congresspassed provides that every 
individual "shall" maintain insurance or else pay a "penalty." 26 U. S. C. 
5000A. This Court, however, saw that the Commerce Clause does not 
authorize a federal mandate to buy health insurance.So it rewrote the 
mandate-cum-penalty as a tax. 567

U. S., at ___-___ (principal opinion) (slip op., at 15-45). The Act that 
Congress passed also requires every State to

Cite as: 576 U. S. ____ (2015) 21

SCALIA, J., dissenting

accept an expansion of its Medicaid program, or else risk losing all 
Medicaid funding. 42 U. S. C. 1396c. This Court, however, saw that the 
Spending Clause does not authorize this coercive condition. So it rewrote 
the law to withhold only the incremental funds associated with the 
Medicaid expansion. 567 U. S., at ___-___ (principal opinion) (slip op., 
at 45-58). Having transformed twomajor parts of the law, the Court today 
has turned its attention to a third. The Act that Congress passed makes 
tax credits available only on an "Exchange established bythe State." This 
Court, however, concludes that this limitation would prevent the rest of 
the Act from working as well as hoped. So it rewrites the law to make tax 
credits available everywhere. We should start calling this law SCOTUScare.
Perhaps the Patient Protection and Affordable Care Actwill attain the 
enduring status of the Social Security Act or the Taft-Hartley Act; 
perhaps not. But this Court's two decisions on the Act will surely be 
remembered through the years. The somersaults of statutory interpretation 
they have performed ("penalty" means tax, "further [Medicaid] payments to 
the State" means only incremental Medicaid payments to the State, 
"established by the State"means not established by the State) will be 
cited by litigants endlessly, to the confusion of honest jurisprudence.And 
the cases will publish forever the discouraging truth that the Supreme 
Court of the United States favors some laws over others, and is prepared 
to do whatever it takesto uphold and assist its favorites.
I dissent.


.


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Place, New York: Cognizant Communication Books.
Wellness Tourism: Bibliographic and Webliographic Essay
David P. Dillard
http://tinyurl.com/p63whl

RailTram Discussion Group
From the Union Pacific to BritRail and Beyond
https://groups.yahoo.com/neo/groups/railtram/info

INDOOR GARDENING
Improve Your Chances for Indoor Gardening Success
http://tech.groups.yahoo.com/group/IndoorGardeningUrban/

SPORT-MED
https://www.jiscmail.ac.uk/lists/sport-med.html
http://groups.yahoo.com/group/sports-med/
http://listserv.temple.edu/archives/sport-med.html

HEALTH DIET FITNESS RECREATION SPORTS TOURISM
https://groups.yahoo.com/neo/groups/healthrecsport/info
http://listserv.temple.edu/archives/health-recreation-sports-tourism.html






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.

Please Ignore All Links to JIGLU
in search results for Net-Gold and related lists.
The Net-Gold relationship with JIGLU has
been terminated by JIGLU and these are dead links.
http://groups.yahoo.com/group/Net-Gold/message/30664
http://health.groups.yahoo.com/group/healthrecsport/message/145
Temple University Listserv Alert :
Years 2009 and 2010 Eliminated from Archives
https://sites.google.com/site/templeuniversitylistservalert/


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SUPREME COURT OF THE UNITED STATES : Syllabus : KING ET AL. v. BURWELL, SECRETARY OF HEALTH AND HUMAN SERVICES, ET AL.

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