In a major victory for the Obama administration, the Supreme Court issued a ruling in the King v. Burwell case upholding the tax subsidies in the Affordable Care Act, also known as Obamacare. The decision was written by Chief Justice John Roberts, who was joined by Justices Anthony Kennedy, Steven Breyer, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan. Justices Antonin Scalia, Clarence Thomas and Samuel Alito dissented.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," the chief justice wrote in his opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter." With the ruling, the Affordable Care Act remains unchanged, and millions of Americans will continue to receive tax subsidies to help pay for health insurance.

At issue in this case was whether the IRS could issue those health insurance tax credits to people in every state, regardless of whether that state had set up its own health exchange or had opted to let the federal government do it. A particular clause in the law ("Exchange established by the State") was the central focus of the case. The government argued that people living in states that chose not to establish an exchange should receive the same subsidies as those people whose states did. The Supreme Court, in a 6–3 vote, sided with the government.

Health policy wonks had followed this case closely since its inception, then as it worked its way through various appeals courts and finally to the Supreme Court, where it was argued in March. During and after oral arguments, it was difficult to guess which way two justices, Roberts and Kennedy, would vote. (The other seven were fairly easy to figure out, either through the questions that they asked or their past writings.)

The final decision went further in support of the administration than many had thought likely. It is a plain-text ruling; in other words, no future president may order a new interpretation of the law that would strip the subsidies from Americans. The Affordable Care Act has now been upheld twice at the Supreme Court (previously in 2012), which could mean that this is the final major legal challenge to the law.

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