Writing for the majority in a 6-to-3 decision, Chief Justice John Roberts rejected arguments positing a significant difference between state and federal insurance exchanges—a difference that would have eliminated the subsidies in the 34 states that did not have state exchanges.
“We are pleased that the Supreme Court upheld subsidies for more than six million people,” said APA President Renée Binder, M.D., in a statement. “Today’s decision means these Americans will continue to receive vital mental health benefits as guaranteed by the ACA. As the physician experts and leaders in mental health treatment, we know there can be no health care without mental health care.”
Acknowledging that there were “more than a few examples of inartful drafting” in the ACA, the court's majority nevertheless chose to look at the “broader structure of the Act” in holding for the government.
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. … The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral,” wrote Roberts. “It is implausible that Congress meant the Act to operate in this manner.”
“For many of our patients, expansion of the ACA has provided a crucial lifeline to access needed health care services, to better engage in treatment, and to experience not just recovery, but to be well again,” said Harsh K. Trivedi, M.D., M.B.A., the chair of APA’s Council on Healthcare Systems and Financing and vice chair for clinical affairs in the Department of Psychiatry at Vanderbilt University in Nashville, Tenn.
“We will continue to work with Congress, the Administration, and the medical community to ensure that mental illness and substance use disorders are treated the same as other illnesses as outlined in the ACA,” added APA CEO and Medical Director Saul Levin, M.D., M.P.A.