Which Avoidance Holding in King v. Burwell?

In Wednesday’s oral arguments, Justice Kennedy seemed highly tempted by a constitutional avoidance argument in King v. Burwell. Although Kennedy’s questions provide some optimism for the government, they have also caused some confusion and consternation. The confusion arises because three different amicus briefs presented constitutionally-motivated arguments (including one that I wrote), and it wasn’t totally clear which argument Justice Kennedy was pursuing. The consternation arises, particularly among liberal commentators, because they worry about a holding that centers on constitutional problems. The biggest concern seems to be that an avoidance holding in King would set dangerous precedent for federalism’s future.

Here, I’ll address the confusion. (In a second, I’ll address the consternation.) On the confusion: I’m entirely sure that Justice Kennedy’s questions arose from the JALSA brief rather than the other two. Here’s why. Continue reading

UPDATE: Death Spirals…Really to the Rescue?

UPDATE: I posted what follows in January, reflecting on the JALSA amicus brief led by Prof. Abigail Moncrieff from BU that argues that petitioners’ interpretation in King v. Burwell would make the ACA unconstitutional by forcing states to choose between establishing exchanges and torpedoing their individual health insurance markets.  In other words, “death spirals to the rescue.”  It looks like that argument got noticed by Justice Kennedy, who pressed the petitioners hard for a response at oral argument this morning.  (See here.)  A very interesting development, and congratulations are in order to Abby and the other JALSA signatories (as well as other amici who pressed this argument) for at the very least helping to call attention to an argument that wound up playing big at argument.  Will be interesting to see how the opinion comes out!

ORIGINAL POST (Jan. 27, 2015):

We’ve heard a lot about “death spirals” and how they could stand in the way of the Affordable Care Act’s goal of a functioning individual health insurance marketplace.  Seth Chandler has an interesting blog devoted to the subject, “ACA Death Spiral.”  And those who have been following King v. Burwell, the Supreme Court’s latest ACA case, have been predicting that a ruling against the government there would be disastrous because it would only exacerbate the “death spiral” threat to individual health insurance markets.  (See a sum-up of such predictions here.)

But could death spirals save the ACA?  According to a fascinating amicus brief filed in the King case by a number of interest groups and co-signed by several prominent law professors and Bill of Health contributors (I understand that Abigail Moncrieff is the driving force behind the brief, joined by Allison Hoffman, Sharona Hoffman, Russell Korobkin, Joan Krause, Stephen Marks,  Kevin Outterson, and Theodore Ruger), the answer might be yes.  The argument boils down to “death spirals to the rescue.”  (Here is a copy: 14-114 bsac JALSA.)

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Death Spirals…to the Rescue!

We’ve heard a lot about “death spirals” and how they could stand in the way of the Affordable Care Act’s goal of a functioning individual health insurance marketplace.  Seth Chandler has an interesting blog devoted to the subject, “ACA Death Spiral.”  And those who have been following King v. Burwell, the Supreme Court’s latest ACA case, have been predicting that a ruling against the government there would be disastrous because it would only exacerbate the “death spiral” threat to individual health insurance markets.  (See a sum-up of such predictions here.)

But could death spirals save the ACA?  According to a fascinating amicus brief filed in the King case by a number of interest groups and co-signed by several prominent law professors and Bill of Health contributors (I understand that Abigail Moncrieff is the driving force behind the brief, joined by Allison Hoffman, Sharona Hoffman, Russell Korobkin, Joan Krause, Stephen Marks,  Kevin Outterson, and Theodore Ruger), the answer might be yes.  The argument boils down to “death spirals to the rescue.”  (Here is a copy: 14-114 bsac JALSA.)

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TOMORROW: Second Annual Health Law Year in P/Review

Please join us for our second annual Health Law Year in P/Review event, co-sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the New England Journal of Medicine. The conference will be held in Wasserstein Hall, Milstein East C at Harvard Law School on Friday, January 31, 2014, from 8:30am to 5:00pm.

This year we will welcome experts discussing major developments over the past year and what to watch out for in areas including the Affordable Care Act, medical malpractice, FDA regulatory policy, abortion, contraception, intellectual property in the life sciences industry, public health policy, and human subjects research.

The full agenda is available on our website. Speakers are:  Continue reading

1/31: Second Annual Health Law Year in P/Review

Please join us for our second annual Health Law Year in P/Review event, co-sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the New England Journal of Medicine. The conference will be held in Wasserstein Hall, Milstein East C at Harvard Law School on Friday, January 31, 2014, from 8:30am to 5:00pm.

This year we will welcome experts discussing major developments over the past year and what to watch out for in areas including the Affordable Care Act, medical malpractice, FDA regulatory policy, abortion, contraception, intellectual property in the life sciences industry, public health policy, and human subjects research.

The full agenda is available on our website. Speakers are:  Continue reading

1/31: Second Annual Health Law Year in P/Review conference

Please join us for our second annual Health Law Year in P/Review event, co-sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the New England Journal of Medicine. The conference will be held in Wasserstein Hall, Milstein East C at Harvard Law School on Friday, January 31, 2014, from 8:30am to 5:00pm.

This year we will welcome experts discussing major developments over the past year and what to watch out for in areas including the Affordable Care Act, medical malpractice, FDA regulatory policy, abortion, contraception, intellectual property in the life sciences industry, public health policy, and human subjects research.

The full agenda is available on our website. Speakers are:  Continue reading

The Newtown Tragedy: Today’s Need for Common-Sense Rhetoric and Regulation

I grew up in a family of gun hobbyists.  One of my older brother’s most treasured Christmas presents from childhood is a rifle that was used in WWII; my dad had a collection of several dozen handguns, shotguns, and rifles, including a semi-automatic AR-15 “assault rifle” and a pearl-plated revolver and holster that he bought with a “Sheriff” badge just for fun; my younger brother is an ex-Marine. Throughout childhood, I spent every weekend of hunting season (and many summer weekends besides) on a West Texas ranch, shooting dove, quail, ducks, and exploding targets attached to grapefruits and ice blocks. And when I went to babysit my niece and nephew for a week in Austin, my brother’s first task was to show me where all of the house’s handguns were kept and how to open the safes he kept them in.

I don’t own a gun myself, and I don’t have any plans to get one. But I understand the utility of guns for both recreation and defense. Of course, as a scholar of health law and constitutional law, I also understand how complex the questions are that guns present for public health and individual liberty. But, as usual, my sense is that there is an obviously correct approach to those complex questions: an approach that seeks balance and optimization. A ban isn’t the right answer, from a policy or constitutional perspective, but in light of the very real dangers that guns present, neither is a strong Second Amendment bar to regulation. Of course, this view represents the current state of the law in both legislation and Supreme Court precedent; the balanced view is inconsistent only with the debate’s heated rhetoric. Here are a few thoughts:

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Video from Obamacare on Trial Panel Discussion

Video is now available from Einer Elhauge‘s recent Obamacare on Trial book talk and panel discussion with Glenn CohenAbbby MoncrieffSanford Levinson, and John McDonough.  Check it out:

http://www.law.harvard.edu/media/2012/11/01_ms.mov

There’s also a new review of the book by the National Law Review available here.

TOMORROW: Einer Elhauge’s Obamacare on Trial – Book Talk and Panel Discussion

Obamacare on Trial

Book talk and panel discussion by Einer Elhauge, Carroll and Milton Petrie Professor of Law, Harvard Law School (and founding director of the Petrie-Flom Center)

Panelists:

Thursday, Nov. 1, 2012, 6:00 pm

Wasserstein Hall, Milstein East A

Harvard Law School

1585 Mass Ave, Cambridge, MA

Sponsored by the Harvard Law School Library

Upcoming Event: 11/01/12 Obamacare on Trial – Book talk and panel discussion with Einer Elhauge

Obamacare on Trial

Book talk and panel discussion by Einer Elhauge, Carroll and Milton Petrie Professor of Law, Harvard Law School (and founding director of the Petrie-Flom Center)

Panelists:

November 1, 2012, 6:00 pm

Wasserstein Hall, Milstein East A

Harvard Law School

1585 Mass Ave, Cambridge, MA

Sponsored by the Harvard Law School Library

Taking Liberties (and Libertarians) Seriously

By Abby Moncrieff

First, an uncontroversial statement: Despite academics’ resistance, libertarian arguments played a huge role in the Supreme Court’s Obamacare decision. That seems obvious. Chief Justice Roberts and the four dissenters based their Commerce Clause analyses largely on notions of individual freedom, asserting that the federal government should not be allowed to force individuals to purchase private products.

But to heath scholars, that line of analysis is incredibly irksome and even a bit dissonant. Health insurance isn’t like ordinary private products, we cry; it is intimately connected to health care regulation, and forcing people to have health insurance, unlike forcing them to buy (or even eat) broccoli, will make them healthier! Congress made this point explicitly, finding that “[t]he economy loses up to $207[ billion] a year because of the poorer health and shorter lifespan of the uninsured”! Failing to eat broccoli doesn’t make you unhealthy the same way that failing to carry insurance does, especially if you’re substituting broccoli with green beans instead of donuts. And eating broccoli doesn’t make you healthy the same way that carrying insurance does, especially if you’re also eating steaks (or eating more than 2000 calories a day of pure broccoli). So, Supreme Court, you just got it wrong. The individual mandate isn’t a crass attempt to get people to buy something. It is, like countless other uncontroversial provisions of the U.S. Code, an attempt to improve the health and longevity of the American people. If you don’t think Medicare (or a Certificate of Need law) infringes liberty, you shouldn’t think the individual mandate does.

Here’s the problem: The Solicitor General didn’t make that argument.

Continue reading