The Affordable Care Act is here to stay.

The Supreme Court on Thursday tossed out the last-gasp long-shot attempt to take down the law. Six justices ruled that, yes, tax-credit subsidies are in fact allowed in every state regardless of whether they run their own exchanges or not.

Chief Justice John Roberts wrote the opinion for King v. Burwell, as he did the last time the Supremes saved the health-case act. But this time it wasn’t a particularly close decision. Republican-appointed Justice Anthony Kennedy as well as the four justices named by Democratic presidents joined the chief justice in full on this one.

For all the fuss, this really was a nothing of a court case. Last time the justices had to think deeply about complex concepts. What does liberty demand? How far should the federal government’s power reach? How do we balance individual choice and community responsibility? What does the Constitution say about all that, and what’s the correct way of understanding the Constitution?

This time …  none of that. As a judicial matter, this was simply about reading a complex law and figuring out what it meant. It is something lawyers are good at. Using the readily available legal toolbox, Roberts concluded that the law as written — although ambiguous — was most sensibly read as extending subsidies to all states. (From the opinion: “[T]he Act’s context 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 to function like their State Exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid.”)

Yes, this is something that everyone, advocates and opponents alike, thought was the case back in 2009-2010 when the law was being drafted, debated and passed.

In practical terms, this was the last real chance that the plan could have been defeated, at least in the states that would have been affected had this decision gone the other way. Yes, Republicans will run on repealing the ACA in 2016. Even if they win the presidency and have majorities in Congress, however, by 2017 it’s going to be far too late to simply repeal the law.

The health-care act would have to be replaced, and any replacement bill — even if Republicans could settle on one — would be filled with political danger. The truth is that Republicans have never displayed any appetite for taking on health-care reform.

This isn’t the last word on health care, of course. Obamacare is hardly an unqualified success by any measure, and even if it was, new technologies and new circumstances will demand new policies. The basic architecture of the ACA — exchanges, subsidies, the individual mandate — is now safe, but that leaves plenty of room for change, and policy entrepreneurs in both parties will be trying to solve challenges unmet by the law as it is.

In other words, we now return — finally — to health care as a normal issue.

Jonathan Bernstein is a Bloomberg View columnist covering U.S. politics.


Only subscribers are eligible to post comments. Please subscribe or to participate in the conversation. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.