# Amicus Curiae Brief — King v. Burwell, 135 S. Ct. 475 (2014) (No. 14-114)

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URL: https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385016_0338%3A64

## Record

- **Collection:** Supreme Court brief
- **Document type:** Amicus Curiae Brief
- **Published:** January 1, 2014

## Text

No. 14-114 —
In The
Supreme Court of the An

¢

DAVID KING, ET AL.,

Petitioners,

w

SYLVIA MATHEWS BURWELL,
AS U.S. SECRETARY OF HEALTH
AND HUMAN SERVICES, ET AL.,

Respondents.
°

On Writ Of Certiorari To The
United States Court Of Appeals
For The Fourth Circuit
e

BRIEF OF THE COMMONWEALTHS OF
VIRGINIA, KENTUCKY, MASSACHUSETTS, AND
PENNSYLVANIA, THE STATES OF CALIFORNIA,
CONNECTICUT, DELAWARE, HAWAII, ILLINOIS,

IOWA, MAINE, MARYLAND, MISSISSIPPI,
NEW HAMPSHIRE, NEW MEXICO, NEW YORK,
NORTH CAROLINA, NORTH DAKOTA, OREGON,
RHODE ISLAND, VERMONT, AND WASHINGTON,
AND THE DISTRICT OF COLUMBIA AS AMICI
CURIAE IN SUPPORT OF AFFIRMANCE
e

MARK R. HERRING STUART A. RAPHAEL*
Attorney Genera! Soliciter General
of Virginia of Virginia
CYNTHIA BAILEY *Counsel of Record
Deputy Attorney General TREVOR S. Cox
KIM PINER Deputy Solicitor General
Senior Assistant
Attorney Generel a OF THE ATTORNEY
CARLY L. RUSH a
Assistant Attorney 900 East Main Street
iemendl Richmond, Virginia 23219
(804) 786-7240
January 28, 2015 sraphael@oag.state.va.us

Counsel for Amici Curiae
[Additional Counsel Listed On Signature Page]

COCKLE LEGAL BRIKFS (800) 726-6964
WWW COCKLELEGALBRIEFS COM

QUESTION PRESENTED

The Patient Protection and Affordable Care Act
provides premium-assistance tax credits to help low-
and moderate-income Americans purchase health
insurance through a State-specific marketplace called
an “Exchange.” Two subsections of 26 U.S.C. § 36B
describe the formula for calculating the tax credit in
reference to a health plan enrolled in through an
“Exchange established by the State under [§] 1311
[42 U.S.C. § 18031].” The Act requires that each
State “shall .establish .an .. Exchange. for
the State,” 42 U.S.C. § 18031(b)(1), and provides that
if a State does not establish the “required Exchange,”
the Secretary of Health and Human Services (HHS)
shal] establish and operate “such Exchange,” 42
U.S.C. § 18041(c)(1). The term “Exchange” is defined
as “an American Health Benefit Exchange estab-
lished under section 18031 of this title.” 42 U.S.C.
§ 300gg-91(d (21).

The Internal Revenue Service (IRS), through
notice-and-comment rulemaking, interpreted the Act
to make tax credits available both in a State that
establishes the required Exchange for itself and in a
State that allows HHS to establish “such Exchange”
in its stead. 26 C.F.R. § 1.36B-1(k); see 77 Fed. Reg.
30,377, 30,378 (2012).

The question presented is whether the IRS
permissibly interpreted the Act to make premium-
assistance tax credits available through the Exchanges
in every State.

i

TABLE OF CONTENTS

Page
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INTEREST OF AMICI CURIAE.......................... l
SUMMARY OF ARGUMENT .......................220000. 2
INT sae dpicccashictinsiervcusenseaesnicmeneneninenenasisccens 3

I. In the nation’s thirty-four FFE States,
millions of citizens depend on tax credits
to afford the health insurance that the
ACA requires them to purchase ................ 3

II. Petitioners’ interpretation would destroy
State insurance markets and render the
Mi i a sa ciamwens i)

Ill. Petitioners’ interpretation of the ACA is
untenable under the Pennhurst doctrine
because Congress did not give the States
clear notice of the alleged consequences
of relying on a federally-facilitated Ex-
I aia data ditesncebecesnnicobaehdncsvteieicbsenstaenmaten 12

A. The Pennhurst doctrine requires that
Congress give States clear notice of
conditions imposed under cooperative-
FSGeraliaGs PLOBTAIIGE. «...06....6005000006008600 12

B. The States selected among Exchange
options without clear notice that the
choice could harm their citizens and
disrupt their insurance markets......... 15

ill

TABLE OF CONTENTS—Continued
Page
C. The States had no clear notice from
the text, structure, purpose or history
of the ACA that citizens in FFE

States would be denied premium-
assistance tax Credits ...............c0.0..0000- 27

IV. The constitutional-doubt canon also coun-
sels against Petitioners’ ACA interpretation,
which raises serious questions under the
ES ESSE SEEN SE ALAA IE TD, BSE 42

CONCLUSION............ Ne este OB el SMa is ad 45

iv

TABLE OF AUTHORITIES
Page

CASES
Abramski v. United States,

Be ae es I ees 29, 30
Arlington Cent. Sch. Dist. Bd. of Ed. v. Murphy,

ee ee aunaoeenaae 13, 27
Bond v. United States,

oR Be Bt a RR a ee Ree se 15
Bond v. United States,

ei es re ar ce eens 44
Chisom v. Roemer,

ee enone 40
Crowell v. Benson,

i oe ee Cr ee ee ee 42
Halbig v. Burwell,

758 F.3d 390 (D.C. Cir. 2014),

reh’g en banc granted, judgment vacated,

No. 14-5018, 2014 WL 4627181 (D.C. Cir.

I i i hess ected umenions 4,10, 39, 41, 42

Halbig v. Sebelius,
No. CV 13-0623 (PLF), 2014 WL 129023

a sees pndmavsvabiaionins 42
King v. Burwell,
759 F.3d 358 (4th Cir. 2014) ..................... 4,9, 37, 42

King v. Sebelius,
997 F. Supp. 2d 415 (E.D. Va. 2014),
aff'd sub nom. King v. Burwell,
Fee ee ee Ce GA COD vhinseietesncngycksnechvcecssnseand 42

TABLE OF AUTHORITIES—Continued

Page

Lebron v. Natl R.R. Passenger Corp.,

ee ee ee eas cinsak bccabascnachucsasewumesneocieken 33
McCarthy v. Bronson,

es eee a sats ald al a eecaettdantuasmtianenonds 29
Nat'l Fed’n of Indep. Bus. v. Sebelius,

ae a ks a Case hicclcncikinkccctbsreatencasaesics passim
New York v. United States,

es ith aoe tances ore Sy eee 14, 43
Pennhurst State Sch. & Hosp. v. Halderman,

Be se Pectin tase natunbuseecincietsakstoanesens passim
Printz v. United States,

UE Pcecadadaaseschatdbcconachinnircincspamtovancienl 43
U.S. Nat'l Bank v. Indep. Ins. Agents of Am.,

Sy ets I Oc oc an ne saeaeh panels cena 29
United States ex rel. Att'y Gen. v. Del. &

Hudson Co.,

Ie rr NO ec 42
United States v. Heirs of Boisdore,

LM pc ae eaten ES BEE Sie tapers ee 29
Util. Air Regulatory Grp. v. EPA,

Ra Re | SA teed ree nt Sem ete et te Om Pace 33
Whitman v. Am. Trucking Ass’ns,

ee ee ME I Da alo aetsas ocicceteeecoieruiesncettons 28

CONSTITUTIONAL PROVISIONS
By Oe NI MINNIE. FE wicseccsccceintsveecresacass 3, 11, 42, 43, 44

vi

TABLE OF AUTHORITIES—Continued

Page
STATUTES
Bee Seas TF NN i Peccewcvcesavecesccciowcsncansinscbesceasaacers 13
26 U.S.C.
Festa td a trea esotts intl Bad SERA Siete ead passim
RS t RRR OEE Ds EE RES AE ah yp eee ew ee 5
Se NIE catececesectnvcek class caceutewvcercoda-sannodsestns 28, 32
Oe Ne cece cp ecanaet coer ila cri ua cdravcdeaspsoavericesseie 5
GT aE CRE SE SAE etait carne 28
a a ha a gk ad dada Dota caenwapey 32
EE Ache tt Mer en oo a ahr oe 30
aE pet aa 6 Re eSB Sec rN rer 30
ae a oo ev ammcenay 36
fA en CAAA SU ot dae LCR A Oe Aer were ae ee a Ow 30
ELE LIE SNR ee eee Enercon 36
Be aka EAS Ae SA ae ee PE 36
ND cre tatoos ecais aa tracth cocrancasadaounduneiwetentdonenn 36
I rain onc lee acer cevas sa aobeatocenvesaetabonpensent 36
Be NE REE EN Gol APS Oto SE el AO 4
I cad iol col Shaairiapaniennt 6
42 U.S.C.
EE Raccneussaunasecus srccrsacasarsasncbibeskanetanens i, 31
Be erie dedicat velequatennyoladeseritenitedenseenereeeseehi 35

it Sl koldstdsadvetensnsnasinnsasvoneresecsencnptinis i, 30, 31, 33, 35

Vii

TABLE OF AUTHORITIES—Continued

Page

© DIB A) ececcnccccscsocececsssvnbiaseasabonaceeeseaie a aaa 4,31

© BE SL os oxnccnnecicsecesshnucteczcutanmeseemes = Gane 1, 4, 31

© RBG TE) .ovccscovseseconsscensdscpedinesscensasnsnsasedeaeteienanaa 31

ROB EIB oseccncecscaccecccsscnsssansseesedscaiscacencseaeeeaaee 31

© RBOBII LMA). .cnsscccccsccsscccvcctensessattinsecen eee 34

DS LBOG RO). .escecesccvesexsssssucsanavcudeesasseeenscnianbints aera 31

BS PROG ECID) cece cescenccorcmsnac cee i, 5, 31, 32, 34

© LOOT ICE) ..00ccsccccnescosevscesesenexsbunseenesevaabiuunsbiaanennannann 5

BD BI ncencnsisescvansecvsssnsesssseccznanteaseesan ie ae 33, 34

DS RING) evccccvecevnvevosncsssksepiecabaouteneea cee 33, 34, 37

§ DOOBIO 1) ...ncccvccvcievicivocansacennentessnasienninueeeenneaane 34
The Patient Protection and Affordable Care Act,

Pub. L. No. 111-148, 124 Stat. 119................. passim
2011 Haw. Sees. Law, Ait DOO cccccesssecevccessesunsssaan 21
Idaho Code Ann. § 41-6102 (West 2014)............0...... 21
N.H. Rev. Stat. Ann. § 420-N:10(1)(h)(1) (2014) ........ 18
REGULATIONS AND ADMINISTRATIVE MATERIALS
BE CBR. § 1.BG- RR) icc scccccsscsvceconecsseuseateeee i, xix
4B CPR. § UGB DD ces ccoucesncsnnsinaccsavssevconsetensteaeee xix
77 Fed. Rew. 16,310 (BOLD) 0... :ccsscccssssersicesenneunaene xix, 4

77 Fed. Reg. 30,377 (2012) .........ssccscccsssseceseseeecsvens i, xix

Vil

TABLE OF AUTHORITIES—Continued
Page

Exec. Order (Beshear) No. 2012-587 (Ky. 2012),
http://apps.sos.ky.gov/Executive/Journal/exec
journalimages/2012-MISC-2012-0587-

Exec. Order (Chafee) No. 11-09 (R.I. 2011),
http://www. healthcare.ri.gov/documents/Exec
%200rder%2011-09%20as%20Signed. pdf ....... 21, 32

Exec. Order (Cuomo) No. 42, 9 N.Y.C.R.R.

a 20
LEGISLATIVE MATERIALS
155 Cong. Rec. $11,964 (Nov. 21, 2009)... 37
155 Cong. Rec. $12,358 (Dec. 4, 2009)......000 00... 38
155 Cong. Rec. $12,779 (Dec. 9, 2009)....................... 38
155 Cong. Rec. $13,375 (Dec. 17, 2009)..................... 38
155 Cong. Rec. $13,559 (Dec. 20, 2009).............000002.. 38

Health Insurance Exchanges: Progress Report:
Hearing Before the Sen. Comm. on Fin., 113th
ag SE a a 19

Verbatim Transcript, Markup of the Reconcilia-
tion Act of 2010, H. Comm. on Budget, 111th
Cong., 2010 WL 941012 (Mar. 15, 2010)................ 39

Wash. H.B. Rep.,
SSB 5445, 2011 Session (2011),
http://apps.leg.wa.gov/documents/billdocs/
2011-12/Pdf/Bill%20Reports/House/5445-
S%20HBR%20APH%2011. pdf ............ cee 17, 32

ix

TABLE OF AUTHORITIES—Continued
Page
OTHER AUTHORITIES

Jonathan H. Adler & Michael] F. Cannon,
Taxation Without Representation: The Illegal

IRS Rule to Expand Tax Credits Under the
PPACA, 23 Health Matrix 119 (2013) .........00000.0.... 39

Vikram David Amar,
Why the Federalism Teachings from the 2012
Obamacare Case Weaken the Challengers’
Case in King v. Burwell, Verdict (Dec. 5,
2014), http://verdict.justia.com/2014/12/05/
federalism-teachings-2012-obamacare-case-
weaken-challengers-case-king-v-burwell............... 30

Arkansas Medicaid,
Proposed Amendment to Health Care Inde-
pendence (aka Private Option) 1115 Waiver,
https://www.medicaid.state.ar.us/general/
comment/demowaivers.aASPpX ................cc.00eeeecceeeeeeee 35

Press Release, Office of Alabama Governor
Robert J. Bentley, Governor Bentley
Announces Alabama Will Not Set Up
State Insurance Exchange (Nov. 13, 2012),
http://governor.alabama.gov/newsroom/2012/
11/governor-bentley-announces-alabama-
will-not-set-up-state-insurance-exchange’............. 24

TABLE OF AUTHORITIES—Continued

Page
Linda J. Blumberg, Matthew Buettgens &

John Holahan,

The Implications of a Supreme Court

Finding for the Plaintiff in King vs. Burwell:

8.2 Million More Uninsured and 35% Higher
Premiums (Jan. 2015),

http//www.urban.org/U ploadedPDF/2000062-
The-Implications-King-vs-Burwell.pdf .......... 7, 8, 11

Jonathan Cohn,

Jonathan Gruber: ‘It Was Just a Mistake,’

An Obamacare architect explains a 2012

quote that’s fueling critics, New Republic

(July 25, 2014),
http://www.newrepublic.com/article/118851/
jonathan-gruber-halbig-says-quote-
exchanges-was-mistake ......................ccc.ccseeeeeeeeeeees 41

Sarah Dash, et al.,

The Ctr. on Health Ins. Reforms,

Georgetown Univ. Health Policy Inst.,
Implementing the Affordable Care Act: State
Decisions about Health Insurance Exchange
Establishment (Apr. 2013),
https://georgetown.box.com/shared/static/
pfmjd22o0f}03z7qes8w3.pdf....................0006 16, 17, 18

Press Release, Office of the Governor, Deal:

Georgia will not set up state exchange

(Nov. 16, 2012),
http://gov.georgia.gov/press-releases/2012-11-
16/deal-georgia-will-not-set-state-exchange .......... 24

x
TABLE OF AUTHORITIES—Continued

A. Doyle,
The Complete Sherlock Holmes (1927)..................

Christine Eibner & Evan Saltzman, RAND Corp..,
The Effect of Eliminating the Affordable
Care Act’s Tax Credits in Federally
Facilitated Marketplaces (Jan. 2015),

http://www.rand.org/pubs/research_reports/
a el St | Be tellin eath, its MR Ah a 10,

Amirah Ellis & Edward Ratledge,
Univ. of Delaware,
Delaware and the Patient Protection
Affordable Care Act (updated Aug. 2011),
http://dhss.delaware.gov/dhcc/files/
issuebrief. pdf

CCCP TOR ET EO RR OER eT FP eR eee ee eee

Eric Eyre,
W.Va. and feds to share health insurance
exchange, W. Va. Gazette (Dec. 10, 2012),
http://www.wvgazette.com/News/
HRI Eni rena TER es is PERSE oe ee

Press Release, Governor Mary Fallin,
Governor Fallin Announces Extension
of Insure Oklahoma (Sept. 6, 2013),
http://www.ok.gov/triton/modules/newsroom/
newsroom_article.php?id=223&article_id=
12653

ee eee eee eee eee eee eee eee eee ee CPP PPP PP PPP PP TPP PPO Pee eee ee eee

xu

TABLE OF AUTHORITIES—Continued
Page

Press Release, Governor Mary Fallin,
Gov. Fallin: Oklahoma Will Not Pursue
a State-Based Exchange or Medicaid
Expansion (Nov. 19, 2012),
http://www.ok.gov/triton/modules/newsroom/
newsroom_article.php?7id=223&article_id=9750 ....... 26

Georgia Health Ins. Exchange Advisory Comm.,
Report to the Governor (Dec. 15, 2011),
https://www.statereforum.org/system/files/
1797658 13ghix_final_report_to_the_governor.

Letter from South Carolina Governor Nikki R.
Haley to Senator Jim DeMint (July 2, 2012),
http-//governor.sc.gov/Documents/Letter% 20to
%20Senator%20DeMint. pdf .................. ce ceeceeees 24, 25

Health Mgmt. Assocs.,
Wakely Consulting Grp., Ji/linois Exchange
Strategic and Operational Needs Assessment,
Final Report (Sept. 2011),
http://egfa.ilga.gov/upload/final%20i1%20
exchange%20needs%20assessment%
FREESE STRAP EAS RCI 1d YE NE emis eee ee 17

Indiana Family & Soc. Servs. Admin..,
Healthy Indiana Plan 1115 Waiver Extension
I Ce. TE, TH hice ncinsitassicecnsacaseconstncsce 35

xiii

TABLE OF AUTHORITIES—Continued
Page
Ins. and Real Estate Comm.,
Joint Favorable Report (Ct. Mar. 15, 2011),

ftp://ftp.cga.ct.gov/2011/JFR/S/2011SB-
RE ON 22

Insure Tennessee,
Waiver Amendment Request, TennCare,
Demonstration Amendment #25,
https://news.tn.gov/sites/default/files/Insure%
20Tennessee%20-%20Waiver%20Amendment.

Iowa Dep’t of Human Servs.,
Iowa Marketplace Choice Plan 1115 Waiver
Application,
http://dhs.iowa.gov/sites/default/files/
IAMktplaceChoice1115_Final.pdf .............0......00.... 35

lowa Dep’t of Human Servs.,
Towa Wellness Plan 1115 Waiver Application
(Aug. 2013),
http//dhs.iowa.gov/sites/default/files/[AWellness

te Ir INO sch cach alcoves onidesicsathadadiskckceuswnmmates 35
Kaiser Family Found.,

Subsidy Calculator (2015),

http://kff.org/interactive/subsidy-calculator/............ 5

Letter from Governor John R. Kasich to
Dir. Gary Cohen, CMMS (Nov. 12, 2012),
http://www.governor.chio.gov/Portals/0/pdf/
11.16.12%20Letter%20to%20HHS. pdf................... 16

XiV

TABLE OF AUTHORITIES—Continued
Page

Larry Levitt & Gary Claxton,
Kaiser Family Found., The Potential
Side Effects of Halbig (July 31, 2014),
http://kff.org/health-reform/perspective/the-
potential-side-effects-of-halbig/ ...................... 6, 7, 10

Annie L. Mach & C. Stephen Redhead,
Cong. Research Serv., R43066, Federal Funding
for Health Insurance Exchanges (2014),
http://fas.org/sgp/crs/misc/R43066. pdf ................... 22

Letter from Governor Jack A. Markell to
Sec’y Kathleen Sebelius (Nov. 14, 2012),
https://www.cms.gov/CCIIO/Resources/
Technical-Implementation-Letters/
Dewnloads/de-exchange-letter.pdf ......................... 19

Maryland Health Care Reform Coordinating
Council,
Final Report and Recommendations
(Jan. 1, 2011),
http://marylandhbe.com/wp-content/uploads/
2012/10/HCRCC-FINALREPORT_jan20111.

Letter from Governor Robert F. McDonnell to
Sec’y Kathleen Sebelius (Dec. 14, 2012),
Amicus Br. for the Commonwealth of
Virginia on Behalf of Defs.-Appellees 25a,
King v. Burwell, 759 F.3d 358 (4th Cir. 2014)
ns Ce ee 18

XV

TABLE OF AUTHORITIES—Continued
Page

Steve Mistler,
Outspoken critic of Obamacare helped to
turn LePage against state exchange,
Portland Press Herald (Nov. 23, 2014),
http://www. pressherald.com/2014/11/23/
outspoken-critic-of-obamacare-hel ped-to-
turn-lepage-against-state-exchange/...................... 27

Christine Monahan,
Halbig v. Sebelius and State Motivations to
Opt for Federally Run Exchanges, Ctr.
on Health Ins. Reforms (Feb. 11, 2014),
http://chirblog.org/halbig-v-sebelius-and-
state-motivations-to-opt-for-federall y-run-
IE ice orocarac reesei cecenis ivaseshccnecaauhee sas venbareneea 26

Nat'l Governors Ass'n,
State Perspectives on Insurance F'xchanges:
Implementing Health Reform in an Uncertain
Environment (Sept. 16, 2011),
http://www.nga.org/files/live/sites/NGA/files/
pdf/LlO9ONGAEXCHANGESSUMMARY.-PDF........ 17

Oregon Health Policy Bd.,
Building Oregon’s Health Insurance
Exchange, A Report to the Oregon Legislature
(Dec. 2010),
http://www.oregon.gov/oha/action-plan/
| PRESSES, AD I EAS AIRE SO DOPE ee:

Pennsylvania Dep’t of Pub. Welfare,
Healthy Pennsylvania 1115 Demonstration
Application (Feb. 2014),
http://www.dpw.state. pa.us/cs/groups/web
content/documents/document/c_071204.pef .......... 36

Xvi

TABLE OF AUTHORITIES—Continued
Page

Pub. Consulting Grp., Alaska Dep’t of Health &
Soc. Servs. Health Ins. Exchange Planning,
Final Report (June 21, 2012),
http://dhss.alaska.gov/Documents/Pdfs/
AKHealthExchangeReport2012.pdf....................... 16

Letter from Governor Pat Quinn to Gary
Cohen, Acting Dir., CMMS (Oct. 16, 2012),
https://www.cms.gov/CCIIO/Resources/
Technical-Implementation-Letters/
Downloads/il-exchange-letter. pdf .........................+ 20

Robert Wood Johnson Found.,
Health Policy Brief, Health Insurance
Exchanges and State Decisions (July 18, 2013),
http://www.rw)f.org/content/dam/farm/reports/
issue_briefs/2013/rwjf407092 ...0..... 0... eeeecceceeeeeeees 17

Antonin Scalia & Bryan A. Garner,
Reading Law: The Interpretation of Legal
SEE nee a 28, 34, 42

South Carolina Health Planning Comm.,
Improving the Health Care Marketplace in
South Carolina (Nov. 2011),
http://doi.sc.gov/DocumentCenter/View/253¢4 ........ 24

U.S. Dep’t of Health & Human Servs.,
Health Insurance Marketplace 2015 Open
Enrollment Period: December Enrollment
Report (Dec. 30, 2014),
http://aspe.hhs.gov/health/reports/2014/
MarketPlaceEnrollment/Dec2014/ib_2014
A No csaricscaksaunnabsbendabennabicneseieovennast) 6

XVll

TABLE OF AUTHORITIES—Continued
Page

U.S. Dep’t of Health & Human Servs.,
The Affordable Care Act is Working,
http//www.hhs.gov/healthcare/facts/factsheets/
2014/10/affordable-care-act-is-working.html........... 7

Washington Health Care Auth.,
Washington State Health Benefit Exchange
Program, Issue Brief #1: Goals and Value
of a Health Benefit Exchange (Jan. 1, 2011),
http://wahbexchange.org/wp-content/
uploads/HBE_Planning Grant_Goal.pdf............... 22

WV Health Benefits Exchange Stakeholder
Meeting Summary (May 9, 2012),
http://bewv. wvinsurance.gov/Portals/2/pdf/
ge Ee a ee 25

Written Testimony of Professor Jonathan
Gruber before the Comm. on Oversight &
Gov't Reform, U.S. House of Representatives
(Dec. 9, 2014),
http://oversight.house.gov/wp-content/
uploads/2014/12/Gruber-Statement-12-9-
IEE IIIIE accents rcienicnestonaniguwersebessnsdssnbinnsondeas 41

Joanne Young,
Heineman opts for federal health care ex-
change, Lincoln Journal Star (Nov. 15, 2012),
http://journalstar.com/news/state-and-
regional/statehouse/heineman-opts-for-
federal-health-care-exchange/article_c8b80018-
c57b-52c7-807c-807535e3533a.html..............0....2... 23

ACA

FFE

IRS Rule

Partnership
Exchange

Secretary

GLOSSARY

Patient Protection and Affordable Care
Act, Pub. L. No. 111-148, 124 Stat.
119, as amended by the Health Care
and Education Reconciliation Act of
2010, Pub. L. No. 111-152, 124 Stat.
1029.

Federally-facilitated Exchange. See 45
C.F.R. § 155.20.

Final regulations, Health Insurance
Premium Tax Credit, 77 Fed. Reg.
30,377 (May 23, 2012) (codified at 26
C.F.R. § 1.36B-1(k)).

A variation of a Federally-facilitated
Exchange in which HHS and States
work together on the operation of an
Exchange. See 77 Fed. Reg. 18,310,
18,325 (2012).

Secretary of the United States
Department of Health and Human
Services.

1

INTEREST OF AMICI CURIAE

The Commonwealths of Virginia and Pennsy]l-
vania and the States of Maine, Mississippi, North
Carolina, and North Dakota elected to forgo estab-
lishing their own Exchange under the ACA with the

understanding that relying on a federally-facilitated
Exchange would not harm State citizens or interfere

with State insurance markets. Sharing that same
understanding, the States of Delaware, Illinois, Iowa,
and New Hampshire implemented a _ federally-
facilitated Exchange through a partnership model,
retaining responsibility for certain core functions while
leveraging the shared federal infrastructure to ensure
financial viability. These amici are “FFE” States.

The States of California, Connecticut, Hawaii,
Maryland, New Mexico, New York, Oregon, Rhode
Island, Vermont, and Washington, the Commonwealths
of Kentucky and Massachusetts, and the District of
Columbia created their own Exchanges with the
understanding that the ACA would provide premium-
assistance tax credits to residents of all States. These
amici are State-Exchange States.

Whether an FFE State or a State-Exchange
State, every State in the union will be affected by the
outcome of this litigation. Petitioners’ erroneous
construction of the ACA would deprive millions of low-
and moderate-income Americans of billions of dollars
in federal premium assistance essential to buy health
insurance, thereby disrupting State insurance mar-
kets throughout the United States and threatening

2

the ability of the ACA to operate as a comprehensive
nationwide program.

Petitioners’ construction would also violate basic
principles of cooperative federalism by surprising the
States with a dramatic hidden consequence of their
Exchange election. Every State engaged in extensive
deliberations to select the Exchange best suited to its
needs. None had reason to believe that choosing a
federally-facilitated Exchange would alter so funda-
mental] a feature of the ACA as the availability of tax
credits. Nothing in the ACA provided clear notice of
that risk, and retroactively imposing such a new
condition now would upend the bargain the States
thought they had struck.

Accordingly, Amici States join together here to
urge the Court to affirm the judgment of the court of
appeals.

o

SUMMARY OF ARGUMENT

The ACA expressly offered States “flexibility”
with respect to the creation and operation of Ex-
changes. A State could establish an Exchange for
itself or rely on HHS to create one. But Petitioners
contend that that offer was not genuine. They claim
that Congress sought to pressure States to create
their own Exchanges, and to punish them for using
an FFE, by (1) making health insurance in FFE
States unaffordable to low- and moderate-income
citizens and (2) rendering insurance markets in FFE

3

States inoperable. That claim has no plausible basis
in the text of the statute. What is more, under the
Pennhurst doctrine, Congress must give States “clear
notice” of conditions imposed under cooperative-
federalism programs. There was no such clear notice
here. To the contrary, State officials reasonably
assumed that premium-assistance tax credits would
be available in every State, regardless of who created
the Exchange.

Petitioners’ interpretation should also be rejected
because it would raise serious questions under the
Tenth Amendment. Petitioners attribute to Congress
a novel kind of coercion that threatens State citizens
and State insurance markets as a means of pres-
suring State governments to take action. Not only is
such a scheme antithetical to the Act’s cooperative-
federalism model, but the constitutional-doubt canon
counsels against attributing such a coercive intention
to Congress.

ARGUMENT

I. In the nation’s thirty-four FFE States,
millions of citizens depend on tax credits
to afford the health insurance that the
ACA requires them to purchase.

As this Court recognized in National Federation
of Independent Business v. Sebelius (““NFIB”), Congress
enacted the ACA “to increase the number of Ameri-
cans covered by health insurance and decrease the

4

cost of health care.”’ The Court in NFIB upheld one
pillar of the ACA, the “individual mandate,” which
requires most Americans to maintain “minimum
essential coverage” for themselves and their depend-
ents.’ A second pillar rests on the guaranteed-issue/
community-rating provisions, which require insurers
to provide coverage and set premiums without regard
to a person’s medical history or prior medical condi-
tion. The third pillar, at issue in this case, is the
provision of premium-assistance tax credits, “an
essential component of the Act’s viability.” These
pillars are aptly characterized as three legs of the
stool; if one leg should fail, the stool will collapse.*

Each State was required to establish an Ex-
change by January 1, 2014.° Congress offered gener-
ous financial grants to assist them.” States were also
given substantial flexibility in choosing how to estab-
lish and operate Exchanges. But if a State elected
not to estal sh an Exchange, or failed to do so, the

' 132 S. Ct. 2566, 2580 (2012).
* 26 U.S.C. § 5000A(a). See NFIB, 132 S. Ct. at 2580, 2601.
* King v. Burwell, 759 F.3d 358, 375 (4th Cir. 2014).

* Halbig v. Burwell, 758 F.3d 390, 418-22 (D.C. Cir. 2014)
(Edwards, J., dissenting), reh'g en banc granted, judgment
vacated, No. 14-5018, 2014 WL 4627181 (D.C. Cir. Sept. 4, 2014)
(en banc).

* 42 U.S.C. § 18031(b\ 1).
* 42 U.S.C. § 18031(a).
" See generally 77 Fed. Reg. 18,310, 18,311 (2012).

5

ACA directed the Secretary to “establish and operate
such Exchange within the State.”

In order to help individual Americans afford the
health insurance that the individual mandate requires
them to buy, Congress provided tax credits to offset
the premium cost. In 26 U.S.C. § 36B, such credits
are provided to “an applicable taxpayer™ whose
family income is between 100% and 400% of the
federal poverty level.” The ACA also provides addi-
tional “cost-sharing reductions” to such individuals. "

It is impossible to overstate the importance of
those tax credits to enable low- and moderate-income
Americans to afford quality health insurance. For
instance, the Henry J. Kaiser Family Foundation’s
widely used subsidy calculator estimates that a single
36-year-old mother of two children living in Rich-
mond, Virginia, earning $25,000 a year (126% of the
federal poverty level), could purchase a silver-level
health-insurance plan for her family for an annual
premium of $3,001, with 83% of that cost ($2,498)
defrayed by the tax credit—meaning that she would
pay only $503 per year.” A single 52-year-old man
earning $20,000 (171% of the poverty level) would

* 42 U.S.C. § 18041(cx 1).
* 26 U.S.C. § 36Bia).

Id. § 36B(cK 1A).

" 42 U.S.C. § 18071(c).

" Kaiser Family Found., Subsidy Calculator (2015),
http://kff_org/interactive/subsidy-calculator/.

6

face a premium of $4,762, but 79% ($3,760) would be
covered by the tax credit, costing him only $1,002 per
year.

The subsidies are crucial to the ACA’s success.
Without them, “many if not most uninsured people
could not afford coverage.” Recognizing that low-
income Americans cannot be penalized for failing to
buy insurance they cannot afford, Congress exempted
those who fail to purchase health insurance if their
premium cost—after tax credits—would exceed 8% of
their household income. With federal subsidies
available, only 3% of those eligible for subsidies
would be exempt from the individual mandate.” In
other words, the ACA both encourages low-income
Americans to buy health coverage and ensures that
they have the means to do so.

Indeed, the proportion of enrollees relying on tax
credits is increasing. In the early months of the 2015
open-enrollment period, 87% of enrollees selected
plans using financial assistance (tax credits and
cost-sharing reductions), compared to 80% in the
early months of last year’s open-enrollment period.”

* Larry Levitt & Gary Claxton, Kaiser Family Found., The
Potential Side Effects of Halbig (July 31, 2014), http://kff.org/
health-reform/perspective/the-potential] -side-effects-of-halbig/.

* 26 U.S.C. § 5000A(e 1A).
° Levitt & Claxton, supra note 13.

* U.S. Dep't of Health & Human Servs., Health Insurance
Marketplace 2015 Open Enrollment Period: December Enrollment
(Continued on following page)

7

Premiums are “holding stable,” and “nearly 8 in 10
current consumers” can obtain monthly coverage “for
$100 or less after tax credits.”"

If the subsidies become unavailable in FFE
States, then 83% of those persons formerly eligible for
subsidies would “end up being exempt from the
individual mandate.”” Their unsubsidized premium
cost would become unaffordable—exceeding 8% of
their income. They and their families would go unin-
sured, taking cold comfort, perhaps, in knowing that
they will not have to pay a tax penalty. The rest
would be required to buy insurance at full cost,
without any subsidy, or pay a penalty for not doing so.

A recent study by researchers at the Urban
Institute predicts that the elimination of premium-
assistance tax credits in the 34 FFE States would
cause more than 9.3 million people to lose almost
$29 billion in subsidies—an average of $3,090 per
person—increasing the number of uninsured by about
8.2 million people.” Table 4 of the study,” reproduced

Report 7 (Dec. 30, 2014), http://aspe.hhs.gov/health/reports/2014/
MarketPlaceEnrollment/Dec2014/ib_2014Dec_enrollment. pdf.

" U.S. Dep’t of Health & Human Servs., The Affordable
Care Act is Working (last visited Jan. 28, 2015), http-/
www.hhs.gov/healthcare/facts/factsheets/201 4/10/affordable-care-
act-is-working. html.

" Levitt & Claxton, supra note 13.

* Linda J. Blumberg, Matthew Buettgens & John Holahan,
The Implications of a Supreme Court Finding for the Plaintiff in
King vs. Burwell: 8.2 Million More Uninsured and 35% Higher

(Continued on following page)

8

in part below, summarizes the impact in each FFE

State:
State Number Total Increase
of People | Value of in the

Losing Tax Number

Tax Credits & | of People
Credits {CSRs Lost/Uninsured

(Millions $)

[FFE] States! 9,346,000) 28,837.7| 8,151,000
abama 165,000 547.1 124,000
Alaska 42,000 232.8 34,000
Arizona 266,000 456.1 237 ,000
Arkansas 128,000 418.8 95,000
Delaware 28,000 92.4 24,000
Florida 1,184,000 3,891.4} 1,073,000
Georgia 461,000 1,524.9 435,000
Illinois 438,000 1,089.0 408,000
Indiana 225,000 924.5 195,000
lowa 98,000 289.2 90,000
Kansas 166,000 419.0 135,000
Louisiana 214,000 857.4 199,000
Maine 62,000 257.0 50,000
Michigan 321,000 905.8 277,000
Mississippi 147,000 568.0 137,000
Missouri 299,000 1,006.8 228,000

Premiums 5 (Jan. 2015), http://www.urban.org/UploadedPDF/
2000062-The-Implications-King-vs-Burwell. pdf.

a

9

Montana 70,000 192.3 61,000
Nebraska 97,000 282.3 83,000
New Hampshire 44,000 116.0 37,000
New Jersey 237,000 727.6 239,000
North Carolina 465,000 1,830.1 407,000
North Dakota 39,000 122.6 29,000
Ohio 497,000 1,510.1 459,000
Oklahoma 208,000 516.0 153,000
Pennsylvania 414,000 1,082.8, 329,000)
South Carolina 241,000 766.3 192,000
South Dakota 51,000 147.1 42,000
Tennessee 320,000 782.7 230,000
Texas 1.566,000 4,358.1; 1,441,000
Utah 162,000 361.6 97,000

irginia 321,000 1,071.4 280,000
West Virginia 41,000 146.3 49,000
Wisconsin 289,000 1,127.9 247,000
Wyoming 40,000 216.3 37,000

Il. Petitioners’ interpretation would destroy
State insurance markets and render the
ACA unworkable.

Withholding premium-assistance
would destabilize insurance markets and “effectively
destroy” the ACA, given the interrelatedness of the
individual mandate, the premium subsidies, and the

* King, 759 F.3d at 379 (Davis, J., concurring).

tax credits

10

guaranteed-issue/communky-rating provisions. Each
leg of the “three-legged stool” is vital.”

The critical function of the subsidies, in par-
ticular, led four Justices in NFIB to conclude that
insurance markets would not function properly
without them:

[The] system of incentives collapses if the
federal subsidies are invalidated. Without
the federal subsidies, individuals would lose
the main incentive to purchase insurance
inside the exchanges, and some insurers may
be unwilling to offer insurance inside of
exchanges. With fewer buyers and even
fewer sellers, the exchanges would not
operate as Congress intended and may not
operate at all.”

Indeed, “[t]he result could be what is commonly called
a ‘death spiral,’ as healthy people exit the market and
premiums rise even more.” Consistent with that pre-
diction, a recent RAND Corporation study concluded
that if subsidies are eliminated in FFE States, en-
rollments will decline by 9.6 million to 4.1 million,
a 70% decrease, and average premiums would

* Halbig, 758 F.3d at 418-22 (Edwards, J., dissenting).

*" 132 S.Ct. at 2674 (joint opinion of Scalia, Kennedy,
Thomas, and Alito, JJ., dissenting).

* Levitt & Claxton, supra note 13.

“ Christine Eibner & Evan Saltzman, RAND Corp.,
The Effect of Eliminating the Affordable Care Act’s Tax Credits
(Continued on following page)

11

increase by 47%.” That combination would “threat-
en|] the viability of the market.” The Urban Insti-
tute study reached comparable conclusions.”

According to Petitioners, those dire consequences
result by design from Congress’s use of “sticks” and
“carrots” to pressure States to create their own Ex-
changes and to deter them from relying on FFEs.” As
shown below, that reading is not only implausible—
it is foreclosed by the Pennhurst doctrine. Congress
did not give States clear notice that their citizens
would be punished and their insurance markets
ruined if the State chose an FFE. And constitutional-
avoidance principles likewise weigh heavily against
Petitioners’ interpretation because the use of such a
threat to pressure States into building their own
Exchanges would raise serious questions under the
Tenth Amendment.

in Federally Facilitated Marketplaces 5 (Jan. 2015),
http://www.rand.org/pubs/research_reports/RR980. html.

* Id.
" Td. at 6.

* Blumberg, Buettgens & Holahan, supra note 19, at 1
(predicting 8.2 million more uninsured people and 35% higher
premiums in FFE States).

* Pet’rs’ Br. 2-3.

12

iil. Petitioners’ interpretation of the ACA is
untenable under the Pennhurst doctrine
because Congress did not give the States
clear notice of the alleged consequences
of relying on a federally-facilitated Ex-
change.

A. The Pennhurst doctrine requires that
Congress give States clear notice of
conditions imposed under cooperative-
federalism programs.

When Congress enacts cooperative-federalism
programs, the States are entitled to clear notice about
the conditions to which they have agreed.” The Court
in Pennhurst State School & Hospital v. Halderman”’
described that clear-statement rule this way:

[Ljegislation enacted pursuant to the spend-
ing power is much in the nature of a con-
tract: in return for federal funds, the States
agree to comply with federally imposed
conditions. The legitimacy of Congress’ power
to legislate under the spending power thus
rests on whether the State voluntarily and
knowingly accepts the terms of the “con-
tract.” There can, of course, be no knowing
acceptance if a State is unaware of the condi-
tions or is unable to ascertain what is ex-
pected of it. Accordingly, if Congress intends
to impose a condition on the grant of federal

* NFIB, 132 S. Ct. at 2602, 2605-06.
" 451 U.S. 1(1981).

13

moneys, it must do so unambiguously. By
insisting that Congress speak with a clear
voice, we enable the States to exercise
their choice knowingly, cognizant of the con-
sequences of their participation.”

In 2006, in Arlington Central School District
Board of Education v. Murphy,” the Court applied
Pennhurst to conclude that expert-witness fees were
not recoverable by a prevailing party under the
Individuals with Disabilities Education Act.“ Writing
for the majority, Justice Alito explained that the
statute must be interpreted from “the perspective of a
state official who is engaged in the process of deciding
whether the State should accept [federal] funds and
the obligations that go with those funds.”” “We must
ask whether such a state official would clearly
understand that one of the obligations of the Act
is the obligation to compensate prevailing parents
for expert fees.”” In other words, “clear notice” is
required.”

The Court applied Pennhurst again in NFIB,
striking down the ACA’s provision that denied all
Medicaid funding to States that failed to adopt

Id. at 17 (citations and footnote omitted).
© 548 U.S. 291 (2006).

* 20 U.S.C. § 1415(iX3XB).

* 548 U.S. at 296 (emphasis added).

* Id. (emphasis added).

~

14

Medicaid expansion. Three Justices concluded that
the States lacked clear notice that participating in
the Medicaid program would subject them to such a
draconian, later-imposed condition.“ Chief Justice
Roberts wrote for the plurality that, while ““Congress’
power to legislate under the spending power is broad,
it does not include surprising participating States
with post-acceptance or ‘retroactive’ conditions.’””
Four other Justices agreed that the Pennhurst
principle applied to the ACA,” but they found the
Medicaid-expansion requirement unconstitutional
because it improperly coerced States into adopting a
federal program.”

Pennhurst’s clear-statement rule is critical to
cooperative federalism. In a cooperative-federalism
model, federal law establishes certain core require-
ments but gives States the freedom to decide whether
and how to implement their own programs within
those requirements. Cooperative federalism respects
State sovereignty by leaving to each State “the
ultimate decision” whether to accept the burdens and
benefits of the federal scheme.” Such local decision-
making promotes “greater citizen involvement in

* 132 S. Ct. at 2602-06 (plurality opinion by Roberts, C.J.,
joined by Breyer and Kagan, JJ.).

* Id. at 2606 (quoting Pennhurst, 451 U.S. at 25).

© Id. at 2659 (joint opinion of Scalia, Kennedy, Thomas, and
Alito, JJ., dissenting).

“ Td. at 2666.
“ New York v. United States, 505 U.S. 144, 168 (1992).

15

democratic processes” and the adoption of “policies
more sensitive to the diverse needs of a heterogene-
ous society.”” But the local deliberation promoted by
cooperative federalism is meaningless if the costs and
benefits of the States’ choices are not transparent.
Permitting hidden consequences to apply retro-

actively undermines a State’s ability to evaluate its
options realistically.

B. The States selected among Exchange
options without clear notice that the
choice could harm their citizens and
disrupt their insurance markets.

The ACA established a cooperative-federalism
model that promised “State Flexibility Relating to
Exchanges.™ Each State engaged in a careful and
thorough deliberative process to choose the Exchange
model best suited to its specific needs. That decision
was not lightly made. The States established commit-
tees and working groups to evaluate Exchange choices;
engaged with federal regulators to understand
the options; hired private consultants to provide
expert advice; solicited public input to understand

“ Bond v. United States, 131 S.Ct. 2355, 2364 (2011)
(quotation marks omitted).

“ 124 Stat. 120 (Title I, Subtitle D, part 3) (emphasis
added).

16

stakeholders’ views; and received grants to assist
with planning.”

While the extensive records of that deliberative
process show that the States relied on many factors
and came to diverse conclusions when selecting an
Exchange model, conspicuously absent is evidence
that States contemplated the dramatic consequence
of depriving their residents of tax credits or destroy-
ing their ow insurance markets. To the contrary,
States as diverse as Alaska,” Ohio,” and Delaware“
weighed the benefits and burdens without ever sug-
gesting that the ACA conditioned premium assistance
on a State’s creating its own Exchange. States
assumed that tax credits would be available without

“ Sarah Dash, et al., The Ctr. on Health Ins. Reforms,
Georgetown Univ. Health Policy Inst., Implementing the Afford-
able Care Act: State Decisions about Health Insurance Exchange
Establishment 2, 15-17 (Apr. 2013), https-//georgetown.box.com/
shared/static/pfmjd220fj03z7qes8w3. pdf.

“ Pub. Consulting Grp., Alaska Dep't of Health & Soc. Servs.
Health Ins. Exchange Planning, Final Report 40 (June 21, 2012),
http-//dhss.alaska.gov/Documents/Pdfs/AKHealthExchangeReport
2012. pdf (tax credits available in “all states”).

” Letter from Governor John R. Kasich to Dir. Gary Cohen,
CMMS (Nov. 12, 2012) (“Regardless of who runs the exchange,

the end product is the same.”), http://www.governor.ohio.gov/
Portals/0/pdf/11.16.12%20Letter%20to% 20HHS. pdf.

“ Amirah Ellis & Edward Ratledge, Univ. of Delaware,
Delaware and the Patient Protection Affordable Care Act 6-7
(updated Aug. 2011), http//dhss.delaware.gov/dhcc/files/issuebrief. pdf
(describing tax-credit availability irrespective of whether HHS
“fulfill[s/"Exchange requirement).

17

regard to which sovereign created the Exchange, as
reflected in reports issued in Illinois,” Oregon,” and
Washington.” And when the National Governors
Association published an Issue Brief in 2011 to assist
States in their deliberations, it did not mention that
tax credits might be unavailable in FFE States.”

The States that decided not to build their own
Exchanges did so for a variety of reasons. Many
determined that they could not complete an Exchange
within the tight federal deadlines, that there were too
many regulatory uncertainties, or that an FFE would
be a stepping stone to eventually creating a State-
based Exchange.” Others did so based on concerns

“ Health Mgmt. Assocs., Wakely Consulting Grp., Illinois
Exchange Strategic and Operational Needs Assessment, Final
Report 2, 11, 20 (Sept. 2011), http-/cgfa.ilga.gov/upload/final% 20i1%
20exchange% 20needs% 20assessment%20091511.pdf.

” Oregon Health Policy Bd., Building Oregon's Health
Insurance Exchange, A Report to the Oregon Legislature 3-5 (Dec.
2010), http://www.oregon.gov/oha/action-plan/exchange-report. pdf.

” Wash. H.B. Rep., SSB 5445, 2011 Session 2-3 (2011), http://
apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bill% 20Reports/
House/5445-S%20HBR%20APH% 2011. pdf.

* Nat'l Governors Ass'n, State Perspectives on Insurance
Exchanges: Implementing Health Reform in an Uncertain
Environment (Sept. 16, 2011), http://www.nga.org/files/live/sites/
NGA/Sfiles/pdf/1109NGAEXCHANGESSUMMARY PDF.

* Dash, supra note 45, at 9-13; Robert Wood Johnson
Found., Health Policy Brief, Health Insurance Exchanges and
State Decisions 4-6 (July 18, 2013), http://www.rw3jf.org/content/
dam/farm/reports/issue_briefs/2013/rwjf407092.

18

about the cost or burden of operating their own
Exchange.”

Conspicuously absent from the Amici States’
deliberations was any notion that choosing an FFE
would deprive citizens of tax credits. For example:

* Virginia Governor Robert F. McDonnell’s
correspondence with Secretary Sebelius
memorialized Virginia’s understanding
“that the choice of a state based, federal,
or hybrid/partnership exchange are all
equally valid in complying with the
law.” Governor McDonnell emphasized
that Virginia was unaware of any “clear
benefits of a state run exchange to our
citizens.””

* New Hampshire enacted legislation that
assumed the availability of tax credits in
its federally-facilitated Exchange. The
statute created an advisory board whose
members must include a person “who
can reasonably be expected to purchase
individual coverage through the ex-
change with the assistance of a premium
tax credit.”

“ Dash, supra note 45, at 12-13.

“ Letter from Governor Robert F. McDonnell! to Sec’y
Kathleen Sebelius (Dec. 14, 2012), Va. Amicus Br. 25a, King v.
Burwell, 759 F.3d 358 (4th Cir. 2014) (No. 14-1158) (ECF No. 36-1).

* Id. at 26a.

* N.H. Rev. Stat. Ann. § 420-N:10(1Xh 1) (2014) (emphasis
added).

19

* Delaware Governor Jack Markell said
that, in selecting a partnership Exchange,
Delaware sought to “leverage a shared
federal infrastructure, retain manage-
ment of critical areas most directly
impacting Delawareans, and ensure
financial viability in light of the size of
our population and market.”” The goal
was “to ensure access to quality afforda-
ble health care for all Delawareans.””
As the governor’s advisor testified before
Congress, Delaware chose the partner-
ship model believing that it would pro-
vide health insurance to a “significant
number” of uninsured Delawareans,
including by providing them “subsidies
through the exchange.””

* [llinois Governor Pat Quinn said that
Illinois opted for a federal partnership
exchange “to increase access to quality
health care and improve the health
of the people of [llinois,” noting that

“ Letter from Governor Jack A. Markell to Sec’y Kathleen
Sebelius (Nov. 14, 2012), https://www.cms.gov/CCIIO/Resources/
Technica!-Implementation-Letters/Downloads/de-exchange-letter.
pdf.

>

© Health Insurance Exchanges: Progress Report: Hearing
Before the Sen. Comm. on Fin., 113th Cong. 35 (2013) (statement
of Bettina Tweardy Riveros, Advisor to the Governor and Chair
of the Delaware Health Care Commission).

20

Iilinoisans “deserve ail the benefits
afforded to them” under the ACA.”

The deliberations of the Amici States that
decided to create their own Exchanges make equally
clear that their decisions were not based on tax-credit
availability. If Petitioners were right, depriving citi-
zens of tax credits would have been the overwhelming
factor warranting a State-based Exchange. But the
States instead mentioned other reasons for their deci-
sion. Many wished to retain control over their own
Exchanges, thereby allowing them to tailor the Ex-
change to regional and local concerns. For instance:

* New York Governor Andrew M. Cuomo
explained that New York would be “best
positioned” to “understand the ramifica-
tions of operating an Exchange within”
the State’s insurance markets and to
“consider the unique regional and eco-
nomic needs” of New Yorkers;

¢ Rhode Island Governor Lincoln D. Chafee
likewise explained that building an Ex-
change would allow Rhode Island to

“ Letter from Governor Pat Quinn to Gary Cohen, Acting
Dir.. CMMS (Oct. 16, 2012) (emphasis added), https://www.
ems.gov/CCIIO/Resources/Technical-Implementation-Letters/
Downloads/il-exchange-letter. pdf.

” Exec. Order (Cuomo) No. 42, 9 N.Y.C.R.R. § 8.42 (N.Y.
2012).

21

maintain “regulatory authority over [its]
commercial health insurance market”;

,

* The Idaho legislature found that “a
state-based health insurance exchange
will provide an Idaho-specific solution
that fits the unique needs of the state of
Idaho”;™ and

* Kentucky Governor Steven L. Beshear
issued an executive order noting that
the fundamental obligations of an
Exchange— including “l|e)nabling eligible
individuals to receive premium tax
credits”—-were the same in “every state
in America,” but finding that a State-
based Exchange would best meet Ken-
tucky’s “unique regional and economic
needs.”

Some States also found that a State-based Exchange
would provide the best system for coordinating with
their preexisting State healthcare programs, 938 in
Kentucky” and Hawaii.” Several Amici States also

“ Exec. Order (Chafee) No. 11-09 (R.1. 2011), http://www.
healthcare.ri.gov/documents/Exec% 200rder% 20 11-09% 20as% 20

Signed. pdf.
“ Idaho Code Ann. § 41-6102 (West 2014).

* Exec. Order (Beshear) No. 2012-587, at 1 (Ky. 2012),
http-//apps.sos. ky.gov/Executive/Journal/execjournalimages/2012
-MISC-2012-0587-222943. pdf.

“ Id. at 2.
et
“ 2011 Haw. Sess. Laws, Act 205, § 2.

22

cited the substantial financial incentives that Con-
gress expressly provided to help them build their own
Exchanges.” Indeed, as of October 2014, the States
had received more than $4.8 billion in such funding.”

These States at no point suggested that they
were building their own Exchanges so their citizens
could enjoy the far more substantial benefits provided
by premium-assistance tax credits. The opposite is
true. For instance, the Washington State Health Care
Authority explained that tax credits would “accrue to
every state regardless of how the state implements an
Exchange.””'

Against all of this evidence, Oklahoma, together
with Alabama, Georgia, Nebraska, and South Carolina,
assert that “[iJn making their Exchange-establishing
decisions, the States were well aware that the plain
text of Section 36B conditioned the availability of tax
credits on States establishing exchanges.”” But the

” Eg., Ins. and Real Estate Comm., Joint Favorable Report
1-2 (Ct. Mar. 15, 2011), ftp://ftp.cga.ct.gov/2011/JFR/S/2011SB-
00921-ROOINS-JFR.htm.

* Annie L. Mach & C. Stephen Redhead, Cong. Research
Serv., R43066, Federal Funding for Health Insurance Exchanges
2 (2014), http://fas.org/sgp/crs/misc/R43066. pdf.

" Washington Health Care Auth., Washington State Health
Benefit Exchange Program, Issue Brief #1: Goals and Value of
a Health Benefit Exchange 2 (Jan. 1, 2011) (emphasis added),
http://wahbexchange.org/wp-content/uploads/HBE_Planning Grant_
Goal_pdf.

™ Okla. Amicus Br. 15.

23

brief cites no evidence for that ipse dixit. Indeed, the
facts appear otherwise.

In Nebraska, Governor Dave Heineman explained
in November 2012 that the State had declined to
create an Exchange due to its high cost.” But he
insisted that the choice would have no adverse affect
on Nebraskans. “On the key issues,” he said, “there is
no real operational difference between a federal
exchange and a state exchange.”

The Georgia Health Insurance Exchange Advisory
Committee advised Governor Nathan Deal that
“Georgians will be eligible for these subsidies whether
the AHBE [American Health Benefit Exchange] in
Georgia is established by the state or federal govern-
ment.” So when Governor Deal announced that
Georgia would not create a State-based Exchange, his
stated reason disclosed no awareness that it would
deprive Georgians of millions of dollars in tax credits;
instead, he objected to “Obamacare’s one-size fits all

™® Joanne Young, Heineman opts for federal health care
exchange, Lincoln Journal Star (Nov. 15, 2012), http://
journalstar.com/news/state-and-regional/statehouse/heineman-
opts-for-federal-health-care-exchange/article_c8b80018-c57b-52c7-
807c-807535e3533a.html.

ai |
™ Georgia Health Ins. Exchange Advisory Comm., Report
to the Governor 13 (Dec. 15, 2011) (emphasis added),

https://www.statereforum.org/system/files/179765813ghix_final_
report_to_the_governor. pdf.

24

approach and the high cost that the law places on
states.””

The rejection of a State-based Exchange by the
Governors of both Alabama” and South Carolina”
similarly referenced opposition to the ACA, and to the
costs imposed on States, but disclosed no awareness
that State citizens would also forfeit billions in
tax-credit dollars. In fact, South Carolina’s Health
Planning Committee assumed that there was no
difference in tax-credit availability,” and Governor
Haley thereafter described Congress’s incentive for
State-created Exchanges to be the “outrageously large”
financial “grants” to assist States in establishing
them, not the availability of tax credits.” She wrote

* Press Release, Office of the Governor, Deal: Georgia will
not set up state exchange (Nov. 16, 2012), http://gov.georgia.gov/
press-releases/2012-11-16/deal-georgia-will-not-set-state-exchange.

“ Press Release, Office of Alabama Governor Robert J.
Bentley, Governor Bentley Announces Alabama Will Not Set Up
State Insurance Exchange (Nov. 13, 2012), http://governor.alabama.
gov/newsroom/2012/11/governor-bentley-announces-alabama-will-
not-set-up-state-insurance-exchange/.

" Letter from South Carolina Governor Nikki R. Haley to
Senator Jim DeMint (July 2, 2012), http://governor.sc.gov/
Documents/Letter% 20to% 20Senator%20DeMint. pdf.

* South Carolina Health Planning Comm., Improving the
Health Care Marketplace in South Carolina 17 (Nov. 2011),
http///doi.sc.gov/DocumentCenter/View/2534 (“if a state chooses
not to create its own exchange, the federal government will
operate one in that state” and “exchanges will provide .
premium and cost-sharing subsidies”).

” Letter from Governor Haley, supra note 78, at 1.

29

that “[bly refusing to implement state-based ex-
changes, the state is ceding nothing . ™

And in West Virginia, State officials answered
“yes” in June 2012 to the question “Will individuals
who are enrolled in coverage through a Federally-
facilitated Exchange have access to premium tax
credits Contemporary news accounts sur-
rounding West Virginia’s decision to forgo a State-
based exchange in favor of an FFE made no mention
that tax credits were available through one but not
the other.”

Oklahoma alone can genuinely claim to be
differently situated. In September 2012, after NFIB
was decided, Attorney General Pruitt added a claim
to Oklahoma’s then-pending lawsuit to argue that
the IRS Rule was impermissible.“ Two months later,
Governor Mary Fallin announced that Oklahoma
would not pursue a State-based Exchange and
that she supported General Pruitt’s “ongoing legal

* 2228.

“ WV Health Benefits Exchange Stakeholder Meeting
Summary 3 (May 9, 2012), http://bewv.wvinsurance.gov/Portals/
2/pdf/CarrierNotesMay2012. pdf.

“ Eric Eyre, W.Va. and feds to share health insurance
exchange, W. Va. Gazette (Dec. 10, 2012), http://www.wvgazette.
com/News/201212100096.

“ Am. Compl. 4 11, Oklahoma ex rel. Pruitt v. Burwell, No.
6:11-cv-00030-RAW (E_D. Okla. Sept. 19, 2012) (ECF No. 35).

26

challenge.” Yet even Oklahoma’s position is not
without contradiction, as the State has continued to
advise eligible Oklahomans that they “qualify for the
federal Health Insurance Marketplace and related
advance premium tax credits.”™

In any event, the fact that some Oklahoma
officials adopted an unusual litigating position in
September 2012 does not demonstrate that the ACA
provided Pennhurst’s objectively “clear notice” when it
was enacted in 2010. Nor does Oklahoma's legal
position show that Officials in other States made their
Exchange-election decisions with knowledge that tax
credits would be unavailable.

To the contrary, the evidence marshaled above,
and by others,” shows that Amici States here, and
officials in nearly every State, lacked any notice, let
alone clear notice, that adopting an FFE would

" See Press Release, Governor Mary Fallin, Gov. Fallin:
Oklahoma Will Not Pursue a State-Based Exchange or Medicaid
Expansion (Nov. 19, 2012), http://www.ok.gov/triton/modules/
newsroom/newsroom_article.php?id=223&article_id=9750.

“ See Press Release, Governor Mary Fallin, Governor Fallin
Announces Extension of Insure Oklahoma (Sept. 6, 2013),
http//www.ok.gov/triton/modules/newsroom/newsroom_article.php?
id=223&article_id=12653 (emphasis added).

“ See also Christine Monahan, Halbig v. Sebelius and State
Motivations to Opt for Federally Run Exchanges, Ctr. on Health
Ins. Reforms (Feb. 11, 2014), http://chirblog.org/halbig-v-sebelius-
and-state-motivations-to-opt-for-federally-run-exchanges/ (finding
little evidence that tax-credit availability played a role in States’
decisions to create a State-based Exchange).

27

deprive citizens of billions in subsidies and destabi-
lize State insurance markets.”

C. The States had no clear notice from

the text, structure, purpose or history
of the ACA that citizens in FFE States
would be denied premium-assistance
tax credits.

From “the perspective of a state official,”” there
was nothing in the text, structure, purpose or history
of the ACA to give them clear notice of Petitioners’
interpretation. The ACA is one of the most elaborate
statutory programs ever devised. It comprises “10

“ Two of Petitioner: amici search for States that might
have made their Exchange-election decisions based on the legal
issue here. Mo. Liberty Project Amicus Br. 15-20; Galen Inst.
Amicus Br. 13-14. Their citation of New Hampshire is clearly
wrong, given that the legislature there required that a New
Hampshire citizen who receives “a premium tax credit” serve on
the State’s advisory board. See note 57 supra and accompanying
text. Their other examples are also based on speculative and
unreliable evidence. For instance, the Missouri Project cites a
recent article in which Petitioners’ amicus, Michae] Cannon,
claims credit for influencing Maine’s decision, although the
article’s author himself concluded from State records that “{iJt’s
unclear from the documents whether the LePage administration
anticipated .. the court case that challenges the legality of
premium subsidies in the federal exchange.” Steve Mistler,
Outspoken critic of Obamacare helped to turn LePage against
state exchange, Portland Press Herald (Nov. 23, 2014), http://
www.pressherald.com/2014/11/23/outspoken-critic-of-obamacare-
helped-to-turn-lepage-against-state-exchange/.

* Arlington Cent., 548 U.S. at 296.

28

titles stretch[ing] over 900 pages and contain[ing]
hundreds of provisions.””

Under Petitioners’ interpretation, the provision
barring federal subsidies in FFE States is buried in
two sub-subsections of 26 U.S.C. § 36B. The phrase
“an Exchange established by the State under
{§) 1311” appears in the provision describing part of
the calculation of an _ individual tax credit
(§ 36B(b\2XA)), and again in the definition of “cover-
age month” (§ 36B(c)2)(A)). Petitioners infer from
that usage that Congress intended to deny tax credits
to citizens in FFE States in order to pressure States
to build their own Exchanges.

But those isolated phrases fail Pennhurst’s
clear-notice test. For starters, Congress does not
“hide elephants in mouseholes.”™ It is unreasonable
to expect State officials to have found clear notice
of Congress’s supposed threat in obscure sub-
subsections of the tax code pertaining to the calcula-
tion of an individual’s tax credit.

What is more, by focusing narrowly on the
phrase “created by the State,” Petitioners violate the
whole-text canon, perhaps the most common mistake
made when interpreting a statute.” “Over and over,”

” NFIB, 132 S. Ct. at 2580.

*" Whitman v. Am. Trucking Ass'ns, 531 U.S. 457, 468
(2001).

™ See Antonin Scalia & Bryan A. Garner, Reading Law:
The Interpretation of Legal Texts 167 (2012) (“Perhaps no
(Continued on following page)

29

this Court has “stressed that ‘liJn expounding a
statute, we must not be guided by a single sentence or
member of a sentence, but look to the provisions of the
whole law, and to its object and policy.’”” Even when
a particular reading of a sentence in one section may
be “the most natural reading .. when viewed in
isolation, statutory language must always be read
in its proper context look[ing] to the particular
statutory language at issue, as well as the language
and design of the statute as a whole.™ Thus, “a court
should not interpret each word in a statute with
blinders on, refusing to look at the word’s function
within the broader statutory context.””

In this case, although the two occurrences of
“established by the State” in § 36B could be read in
isolation to support Petitioners’ view, “all of the other
evidence from the statute points the other way.””
Within § 36B itself, subsection (a}—which establishes
the right to tax credits—authorizes tax credits for
“applicable taxpayer[s],” a term whose definition does
not turn on whether the taxpayer’s own State has

interpretive fault is more common than the failure to follow the
whole-text canon... .”).

© U.S. Nat'l Bank v. Indep. Ins. Agents of Am., 508 U.S.
439, 455 (1993) (quoting United States v. Heirs of Boisdore, 49
U.S. 113, 122 (1849)) (emphasis added).

“ McCarthy v. Bronson, 500 U.S. 136, 139 (1991).

* Abramski v. United States, 134 S.Ct. 2259, 2267 n.6
(2014).

* U.S. Nat'l Bank, 508 U.S. at 455.

30

itself set up the Exchange. Other provisions of § 36B
addressing the tax-credit calculation use the term
“Exchange” by itself.” State officials reviewing § 36B
therefore would have had no sensible reason to con-
clude, let alone clear notice, that the two occurrences
of “established by the State” had the far-reaching
effect Petitioners assert.

And even if State officials had zeroed in on the
phrase “Exchange established by the State under
§ 1311”—“the way Waldo’s whereabouts” are revealed
when flagged with a highlighter’—they would still
have to look up the meaning of the defined-and-
capitalized term “Exchange,” and then look at § 1311
(42 U.S.C. § 18031) to see what that section says
about it. So the language in § 36B “merely raises,
rather than answers, the critical question . ™ “In
answering that inquiry, we must (as usual) interpret
the relevant words not in a vacuum, but with re’er-
ence to the statutory context, structure, history, and
purpose,. nottomentioncommonsense . .””

* See 26 U.S.C. § 36B(dX3XB), (eX3), (£3).

“ Vikram David Amar, Why the Federalism Teachings from
the 2012 Obamacare Case Weaken the Challengers’ Case in King
v. Burwell, Verdict (Dec. 5, 2014), http://verdict.justia.com/
2014/12/05/federalism-teachings-2012-obamacare-case-weaken-
challengers-case-king-v-burwell.

” Abramski, 134 S. Ct. at 2267.
'” Id. (quotations omitted).

31

Section 1311 provides that “Each State shall, not
later than January 1, 2014, establish an American
Health Benefit Exchange (referred to in this title as
an ‘Exchange’).””’ Congress provided financial assis-
tance to help States do so.” But what if a State did
not want to build an Exchange or would not have it
operational by 2014? Section 1321(c) (42 U.S.C.
§ 18041(c)) took care of that: the Secretary shall
“establish and operate such Exchange within the
State.”

So is a federally-facilitated Exchange (“such
Exchange”) the same, for purposes of the ACA, as an
Exchange “established by the State”? Yes, because the
word “Exchange” is a defined term of art, and the
only kind of Exchange defined in the ACA is an
Exchange established by the State under § 1311.

“Exchange” is,defined in 42 U.S.C. § 300gg-
91(d)(21) as “an American Health Benefit Exchange
established under section 18031 [ACA § 1311] of chis
title.” There is no other definition of “Exchange” and
no separate definition of an Exchange established
by the Secretary. Section 18031(d) repeats the
point by making it a general requirement that an
Exchange “shall be a governmental agency or non-
profit entity that is established by a State.” And the

' 42 U.S.C. § 18031(bx 1).

' 42 U.S.C. § 18031(a).

42 U.S.C. § 18041(cX 1) (emphasis added).
™ 42 U.S.C. § 18031(d\(1) (emphasis added).

32

defined-and-capitalized term “Exchange” is then used
throughout the ACA, including in the tax-credit
provisions in § 36B.

Returning to § 18041(cX1), the “such Exchange”
that the Secretary establishes (when the State does
not) is properly treated as the “Exchange established
by the State under § 1311.” That is so because there
is no other Exchange defined in the ACA that it could
be. Indeed, officials in various States repeatedly
noted that the Exchange would be legally the same
regardless of which sovereign created it." As Mary-
land’s agency put it: “The ACA provides that all states
must either create their own health benefit exchanges
or allow the federal government to do it for them.”

Petitioners pay scant attention to the ACA’s
statutory definition, relying instead on a colloquial
understanding of “Exchange established by the State”
in § 36B(bX2KA) and (c)2A\1). But the statutory
definition is essential, for the definition Congress
assigns is “assuredly dispositive” of its scope
“for purposes of matters that are within Congress’

' E.g., Exec. Order (Chafee), supra note 63, at 1 (“if a state
does not elect to establish an Exchange, [HHS] shall establish
and operate such Exchange within the state”); Wash. H.B. Rep.,
SSB 5445, supra note 51, at 2 (“If a state chooses not to establish
an AHBE, the federal government will operate an AHBE.”).

'“ Maryland Health Care Reform Coordinating Council,
Final Report and Recommendations 14 (Jan. 1, 2011), http-//
marylandhbe.com/wp-content/uploads/2012/10/HCRCC-FINAL
REPORT_jan20111. pdf.

33

control.” Thus, the Court in NFIB found that the
individual mandate was not a “tax” for purposes of
the Anti-Injunction Act because Congress called it a
“penalty,” even though the constitutionality of the
individual mandate depended on its characterization
as a “tax” for constitutional purposes.” Congress can
likewise say that “such Exchange” established by the
Secretary counts as the Exchange established by the
State in discharge of its obligation to create one
under § 18031.

The ACA may not be “a chef d’oeuvre of legisia-
tive draftsmanship. But we must do our 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.”

Under the whole-text canon, moreover, other
provisions of the ACA confirm that Petitioners’ read-
ing is untenable. For example, § 18083 directs the
Secretary to ensure that residents of “each State”
may enrol] in an Exchange in a manner that gives
them access to premium-assistance tax credits.
Subsection (a) requires the Secretary to “establish a
system . under which residents of each State may

'” Lebron v. Nat'l R.R. Passenger Corp., 513 U.S. 374, 392
(1995).

™ See NFIB, 132 S. Ct. at 2583, 2594.

‘ Util. Air Regulatory Grp. v. EPA, 134 S. Ct. 2427, 2441
(2014) (citation and quotation omitted).

34

apply for enrollment in, receive a determination of
eligibility for participation in, and continue participa-
tion in, applicable State health subsidy programs.”’”
Subsection (e) defines “applicable State health subsi-
dy programs” as “including the premium tax credits
under section 36B of title 26.” Thus, section 18083

shows that Congress intended for tax credits to be
available in “each State.”

The ACA also defines a “qualified individual” who
can enroll in an Exchange as “an individual who
resides in the State that established the Exchange.”’”
If Petitioners’ theory were applied to that section, no
one would be eligible to enroll in a federally-
facilitated Exchange because it would not be an
Exchange that the State itself has established. That
reading makes no sense and would violate the pre-
sumption against ineffectiveness.’ By contrast,
reading “Exchange” as a single defined term—an
American Health Benefit Exchange that the State is
required to establish, whether by doing so itself or by
letting the Secretary establish “such Exchange within
the State” on its behalf—resolves the conundrum
throughout the ACA.

" 42 U.S.C. § 18083(a) (emphasis added).

™ Id. § 18083(eX 1).

'* 42 U.S.C. § 18032(fX 1A) (emphasis added).
'" Scalia & Garner, supra note 92, at 63.

™* 42 U.S.C. § 18041(cX1).

35

The ACA’s Medicaid maintenance-of-effort provi-
sion would also become dysfunctional in Petitioners’
world. That provision states that until “the date on
which the Secretary determines that an Exchange
established by the State under section 18031 of this
title is fully operational,” the State cannot make its
Medicaid-eligibility standards “more restrictive” than
those in effect on March 23, 2010.’ Under Petition-
ers’ interpretation, FFE States would never come into
compliance and would have their Medicaid-eligibility
standards frozen indefinitely. Ironically, the FFE
States that have applied for and received approval of
more restrictive Medicaid-eligibility standards in-
clude three of Petitioners’ amici—Oklahoma, Indiana,
and Nebraska.’ Indiana has even used tax-credit
availability as one of the justifications for its waiver
request.’ Other FFE States have likewise submitted
waiver applications to HHS that assume the availa-
bility of tax credits, such as Arkansas,'" Iowa,’”

'® 42 U.S.C. § 1396a(ggX 1) (emphasis added).
" Resp'ts’ Br. 29.

‘" Indiana Family & Soc. Servs. Admin., Healthy Indiana
Plan 1115 Waiver Extension Application 29, 44 (Apr. 12, 2013),
Indiana v. I.R.S., No. 1:13-cv-01612 (S.D. Ind. Apr. 16, 2014),
ECF No. 61-11.

'™* Arkansas Medicaid, Proposed Amendment to Health Care
Independence (aka Private Option) 1115 Waiver 3, https://www.
medicaid. state.ar.us/general/comment/demowaivers.aspx.

"* lowa Dep’t of Human Servs., Jowa Wellness Plan 1115
Waiver Application 8, ‘.1, 29, 49 (Aug. 2013), http://dhs.iowa.gov/
sites/default/files/LAWeilnessPlan1115_Final.pdf.; Jowa Marketplace

(Continued on following page)

36

Pennsylvania,” and Tennessee.” That practical con-
struction further confirms that “Exchange established
by the State” means the defined Exchange estab-
lished under § 1311, regardless of whether the State
itself establishes it or the Secretary establishes “such
Exchange” on the State’s behalf.

Finally, the Petitioners’ theory would make
surplusage of the reporting requirements in § 36B(f).
That section requires all Exchanges to report to the
Secretary six categories of information (subsections
A-F) for each health plan purchased. Four of the six
involve tax-credit information: (B), the “total premi-
um for the coverage without regard to the credit”; (C),
the “aggregate amount of any advance payment of
such credit”; (E), “[aJny information provided to the
Exchange . necessary to determine eligibility for,
and the amount of, such credit”; and (F), “information
necessary to determine whether a taxpayer has
received excess advance payments.” That reporting
requirement would make little sense if credits were
unavailable in FFE States.

Choice Plan 1115 Waiver Application 3, http://dhs.iowa.gov/
sites/default/files/LAMktplaceChoice 1115_Final. pdf.

’ Pennsylvania Dep't of Pub. Welfare, Healthy Pennsylvania
1115 Demonstration Application 10-12 (Feb. 2014), http://www.
dpw.state. pa.us/cs/groups/webcontent/documents/document/c_
071204. pdf.

'* Insure Tennessee, Waiver Amendment Request, TennCare,
Demonstration Amendment #25 1, https://news.tn.gov/sites/default/
files/Insure®20Tennessee%20-%20 Waiver%20Amendment. pdf.

'™ 26 U.S.C. § 36B(fX3XB), (C), (E), (F).

37

Petitioners’ construction also undermines the
clear purpose of the ACA as reflected in its statutory
text and structure: to provide affordable health
insurance to as many Americans as possible. The
requirement in § 18083(a) to ensure enrollees’ ability
to qualify for tax credits in “each State” is but one
example. More broadly, the title in which § 36B
appears is called “Quality, Affordable Health Care for
All Americans.” The subtitle is “Affordable Cover-
age Choices for All Americans.” Congress’s choice of
the word “all” confirms that the phrase Petitioners
pluck from § 36B was not meant to deny affordable
health coverage in FFE States and to destroy State
insurance markets.

Although the court of appeals found the ACA’s
legislative history “not particularly illuminating on
the issue of tax credits,” to the States’ ears, Con-
gress spoke loudly and one-sidedly to the point at
issue here:

e Senator Baucus said “tax credits will
help to ensure a/l Americans can afford
quality health insurance.”"”

¢ Senator Johnson said the ACA will “form
health insurance exchanges in every
State through which those limited to the

'* 124 Stat. 130 (emphasis added).

™ 124 Stat. 213 (emphasis added).

’ King, 759 F.3d at 371.

'* 155 Cong. Rec. $11,964 (Nov. 21, 2009) (emphasis added).

38

individual market will have access to
affordable and meaningful coverage.”

* Senator Durbin said “we will help you
pay your health insurance premiums,
give you tax breaks to pay those premi-
ums. That means a lot of people who
today cannot afford to pay for health
insurance premiums will be able to.””
He added that “30 million Americans
today who have no health insurance
will qualify for . tax credits to help
them pay their premiums so they can
have and afford health insurance.”

e Senator Bingaman said that the ACA
“includes creation of a new health insur-
ance exchange in each State which will
provide Americans. meaningful private
insurance as well as refundable tax
credits to ensure that coverage is afford-

able.”"”

One of the ACA’s staunchest opponents, Representa-
tive Paul Ryan, criticized the law because it made tax
credits available in every State:

[I]t’s a new, open-ended entitlement that
basically says that just about everybody
in this country—people making less than

‘*" 155 Cong. Rec. $13,375 (Dec. 17, 2009) (emphasis added).
‘* 155 Cong. Rec. S12,779 (Dec. 9, 2009).

™ 155 Cong. Rec. $13,559 (Dec. 20, 2009) (emphasis added).
‘ 155 Cong. Rec. $12,358 (Dec. 4, 2009) (emphasis added).

39

$100,000, you know what, if your health care
expenses exceed anywhere from 2 to 9.8
percent of your adjusted gross income, don’t
worry about it, taxpayers got you covered,
the government is going to subsidize the
rest.”

As the States watched and listened o those
debates, none of those statements would have made
sense had Congress intended to withhold tax credits
in FFE States. Tellingly, even Petitioners’ amici—
Jonathan Adler and Michael Cannon, the two con-
servative commentators who later published the
roadmap for Petitioners’ legal challenge—admitted
that they “were both surprised to discover this feature
of the law and initially characterized it as a
‘glitch.’”" Judge Edwards of the D.C. Circuit put it
more cynically: Petitioners’ “incentive story is a
fiction, a post hoc narrative concocted to provide a
colorable explanation for the otherwise risible notion
that Congress would have wanted insurance markets
to collapse in States that elected not to create their
own Exchanges.”

™ Verbatim Transcript, Markup of the Reconciliation Act of
2010, H. Comm. on Budget, 111th Cong., 2010 WL 941012 (Mar.
15, 2010) (emphasis added).

'™ Jonathan H. Adler & Michael F. Cannon, Taxation
Without Representation: The Illegal IRS Rule To Expand Tax
Credits Under the PPACA, 23 Health Matrix 119, 123 (2013)
(emphasis added).

' Halbig, 758 F.3d at 416 (Edwards, J., dissenting).

40

From the States’ perspective, then, not only was
there no “clear notice” that opting for a federally-
facilitated Exchange would deny citizens tax credits
and ruin insurance markets, but a chorus of congres-
sional leaders uniformly signaled the opposite. Con-
gress promised a cooperative-federalism model, one
promoting “State Flexibility Relating to Exchang-
es,” not a model based on federal threats and coer-
cion. Indeed, the most significant aspect of the
legislative history is the absence of any evidence
supporting Petitioners’ interpretation.

“Congress’ silence in this regard can be likened to
the dog that did not bark,” from which Sherlock
Holmes deduced that the perpetrator must have been
known to the dog.” If anyone in Congress had actually
proposed coercing the States in the manner claimed
by Petitioners, it would have engendered howls of
protest from the ACA’s opponents and from those who
normally resist efforts by the federal government to
impose undue pressure on the States. Yet there was
not so much as a growl of disapproval about the
iniquitous scheme Petitioners postulate here.

The best that Petitioners and their amici come
up with are YouTube videos of Professor Jonathan

™ 124 Stat. 120 (Title 1, Subtitle D, part 3) (emphasis
added).

‘ Chisom v. Roemer, 501 U.S. 380, 396 n.23 (1991).

'“ Id. (citing A. Doyle, Silver Blaze, in The Complete
Sherlock Holmes 335 (1927)).

41

Gruber, a private citizen appearing at non-
governmental meetings years after the ACA was
enacted.” But they fail to demonstrate that Professor
Gruber’s message was disseminated to the State
officials responsible for determining whether to build
their own Exchange. In any event, Gruber later cor-
rected himself, calling his earlier statements a mis-
take’ and pointing out that his own economic
simulations “expressly modeled for the citizens of
all states to be eligible for tax credits, whether
served directly by a state exchange or by a federal
exchange.”

Judge Edwards was correct in Halbig v. Burwell
that the ACA provided no “notice to States that their
taxpayers will be denied subsidies if the State elects
to have HHS create an Exchange on its behalf.”
If that consequence could not be discerned by the

'" See, e.g., Pet'rs’ Br. 4-., 42-43; Sen. Cornyn Amicus Br.
13-14; Mountain States Legal Found. Amicus Br. 10.

‘* Jonathan Cohn, Jonathan Gruber: ‘It Was Just a Mistake,
An Obamacare architect explains a 2012 quote that’s fueling
critics, New Republic (July 25, 2014), http://www.newrepublic.

com/article/118851/jonathan-gruber-halbig-says-quote-exchanges-
was-mistake.

'* Written Testimony of Professor Jonathan Gruber before
the Comm. on Oversight & Gov't Reform, U.S. House of Repre-
sentatives 2 (Dec. 9, 2014) (emphasis added), http://oversight.
house.gov/wp-content/uploads/2014/12/Gruber-Statement-12-9-
ObamaCare1.pdf.

'® 758 F.3d at 421 (Edwards, J., dissenting).

42

federal district judge in this case,’ nor by the one in
Halbig,"” nor by (now) four federal circuit judges,
how could the States have been on “clear notice”?

IV. The constitutional-doubt canon also coun-
sels against Petitioners’ ACA interpretation,

which raises serious questions under the

Tenth Amendment.

“A statute should be interpreted in a way that
avoids placing its constitutionality in doubt.” The
constitutional-doubt canon “militates against not only
those interpretations that would render the statute
unconstitutional but also those that would even raise
serious questions of constitutionality.”“” Because
Petitioners’ interpretation would raise a very serious

‘" King v. Sebelius, 997 F. Supp. 2d 415, 427-32 (E.D. Va.
2014) (Spencer, J.), aff'd sub nom. King v. Burwell, 759 F.3d 358
(4th Cir. 2014).

‘® Halbig v. Sebelius, No. CV 13-0623 (PLF), 2014 WL
129023, at *18 (D.D.C. Jan. 15, 2014) (Friedman, J.), rev'd and
remanded sub nom. Halbig v. Burwell, 758 F.3d 390 (D.C. Cir.
2014), reh’g en banc granted, judgment vacated, No. 14-5018,
2014 WL 4627181 (D.C. Cir. Sept. 4, 2014).

'* King, 759 F.3d at 372-73 (Gregory, J., joined by Thacker,
J.); id. at 376 (Davis, J., concurring); Halbig, 758 F.3d at 426
(Edwards, J., dissenting).

‘“ Scalia & Garner, supra note 92, at 247 (citing United
States ex rel. Att’y Gen. v. Del. & Hudson Co., 213 U.S. 366, 408
(1909)).

* Id. at 247-48 (citing Crowell v. Benson, 285 U.S. 22, 62
(1932)).

43

constitutional question under the Tenth Amendment,
their reading of the ACA should be rejected.

In New York v. United States“ and Printz v. United
States,’ this Court recounted the Framers’ choice to
adopt a federal system that operates without coercing
States into implementing federal programs. In NFIB,
the Court explained that cutting off all Medicaid
funding to States that declined Medicaid expansion
constituted “much more than relatively mild encour-
agement—it is a gun to the head.” It “‘crossed the
line distinguishing encouragement from coercion,’”’”

serving “no purpose other than to force unwilling
States” to comply.”

In the court of appeals, Petitioners argued that
the scheme they attribute to Congress was “the same”
in its coercive nature as one invalidated in NFIB.™'
In this Court, Petitioners prefer understatement,
saying that “Congress could quite reasonably believe
that elected state officials would not want to explain
to voters that they had deprived them of billions of

‘ 505 U.S. at 164-66.
“" 521 U.S. 898, 919-22 (1997).

‘“ 132 S. Ct. at 2604 (plurality) (quotation omitted); see also
id. at 2659-66 (joint opinion of Scalia, Kennedy, Thomas, and
Alito, JJ., dissenting) (agreeing mechanism was coercive).

‘* Id. at 2603 (plurality) (quoting New York, 505 U.S. at
175).

~ oe.

‘* Appellants’ Opening Br. 44, King v. Sebelius, 759 F.3d
358, 375 (4th Cir. 2014) (No. 14-1158), ECF No. 14.

44

dollars by failing to establish an Exchange.””” Either
way, it is a novel kind of pressure to threaten to
injure a State’s citizens and to destroy its insurance
markets in order to force State-government officials
to implement a federal program.

This Court recently said in Bond v. United States
that “if the Federal Government would radically
readjust| ] the balance of state and national authority,
those charged with the duty of legislating [must be]
reasonably explicit about it.”"” As in Bond, Congress
was not “utterly clear” about that here. And because
Petitioners’ interpretation of the ACA would raise
a serious Tenth Amendment question, it must be
rejected in favor of the Government’s more plausible
reading, which avoids that infirmity.

+

'% Pet’rs’ Br. 32.
“° 134 S. Ct. 2077, 2089 (2014) (quotations omitted).
'™ Td. at 2093.

45

CONCLUSION
The judgment of the court of appeals should be

affirmed.

Respectfully submitted,

MARK R. HERRING
Attorney Genera] of Virginia

CYNTHIA BAILEY
Deputy Attorney General

KIM PINER
Senior Assistant Attorney
General

CARLY L. RUSH
Assistant Attorney General

January 28, 2015

STUART A. RAPHAEL*
Solicitor General of Virginia

TREVOR S. Cox
Deputy Solicitor General

OFFICE OF THE ATTORNEY
GENERAL

900 East Main Street

Richmond, Virginia 23219

(804) 786-7240 — Telephone

(804) 371-0200 — Facsimile

sraphael@oag.state.va.us

*Counsel of Record

46

KAMALA D. HARRIS JANET T. MILLS

Attorney General of California Attorney General of Maine

1300 I Street, Suite 125 6 State House Station

Sacramento, CA 95814 Augusta, ME 04333

GEORGE JEPSEN BRIAN E. FROSH

Attorney Genera! Attorney General of Maryland
of Connecticut 200 Saint Paul Place

55 Elm Street . Baltimore, MD 21202

Hartford, CT 06106

MAURA HEALEY
MATTHEW P. DENN Attorney General
Attorney General of Delaware of Massachusetts
820 N. French Street, 6th Floor One Ashburton Place

Wilmington, DE 19801 Boston, MA 02108
KARL A. RACINE Jm™m Hoop
Attorney General for the Attorney General of
District of Columbia Mississippi
441 4th Street, NW P.O. Box 220
Washington, DC 20001 Jackson, MS 39205
RUSSELL A. SUZUKI JOSEPH A. FOSTER
Attorney General of Hawaii Attorney General of
425 Queen Street New Hampshire
Honolulu, HI 96813 33 Capitol Street
Lisa MADIGAN Concord, NH 03301

Attorney General of Illinois Hector H. BALDERAS
100 West Randolph Street, Attorney General of

12th Floor New Mexico
Chicago, IL 60601 P.O. Drawer 1508
Tom MILLER Santa Fe, NM 87504
Attorney General of Iowa Eric T. SCHNEIDERMAN
1305 E. Walnut Street Attorney General of
Des Moines, [A 50319 New York

120 Broadway, 25th Floor

JACK CONWAY New York, NY 10271

Attorney General of Kentucky
700 Capitol Avenue, Suite 118
Frankfort, KY 40601

47

Roy COOPER
Attorney General of
North Carolina

P.O. Box 629
Raleigh, NC 27602

WAYNE STENEHJEM
Attorney General of

North Dakota
600 E. Boulevard Avenue

Bismarck, ND 58505

ELLEN F. ROSENBLUM
Attorney General of Oregon
1162 Court Street, N.E.
Salem, OR 97301

KATHLEEN G. KANE

Attorney General of
Pennsylvania

16th Floor, Strawberry Square

Harrisburg, PA 17120

PETER F. KILMARTIN

Attorney General of
Rhode Island

150 South Main Street

Providence, RJ 02903

WILLIAM H. SORRELL
Attorney General of Vermont
109 State Street
Montpelier, VT 05609

ROBERT W. FERGUSON

Attorney General of
Washington

P.O. Box 40100

1125 Washington Street SE

Olympia, WA 98504

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385016_0338%3A64. Public record. Not legal advice.
