Project Summary: I want to 2 paper for 2 person in different answers For each paper has different answers Can you finish this papers before 6 hours Patient Protection Affordable Care Act IV King v. Burwell In addition to the Act, the Act requires the creation of an exchange in each state that allows people to compare and purchase insurance plans. The Act gives each state the opportunity to establish its own but establishes the fed govt each exchange if the state does not. The IRS regulations interprets that language as making tax credits available on an exchange regardless of whether the exchange is established and operated by a state or by HHS. In Burwell the Petitioners argue that the Virginia exchange does not qualify as an exchange established by the state, therefore they should not receive any tax credits. Without the credits would cause the cost of purchasing insurance more than 8% of their income exempting them from the coverage requirement. However as a result of the IRS rule, petitioners would receive the tax credits thereby subjecting them to the Acts coverage requirement. The Supreme Court in interpreting statutory language , where the language is plain and unambiguous, the court must interpret the plain meaning of the statue. In context of ambiguity , the court must look to whether permissible meaning produces substantative effect that is comparable to rest of law. The court determined that state and Federal exchanges would differ in a fundamental way if tax credits only were available on State exchanges. The court therefore determined at least on this issue that while their plain meaning argument is strong, the Acts context and structure compel the conclusion that allows for tax credits for insurance purchase on any exchange created under the ACT. The ACA grew out of several failures by several states to insure residents the right to health insurance. The general common approach underlying those attempts was the Guarantee issue requirement which barred insurer from denying coverage to any person because of health and a community rating requirement, which barred insures from charging a person higher premiums for the same reason. The unintended consequence of these two goals was that people waited until they became ill to purchase health insurance. They could purchase insurance for the same price when they became ill as opposed to just paying premiums while healthy. The second consequence led to insurers being force to increase premiums to account for the fact that it was becoming more and more the sick rather than the healthy that were buying insurance.. This caused the insured numbers to decrease and in fact many insurers left the market place entirely. In 1996 Massachusettes adopted the guaranteed issue and community ratings requirements and experienced the same results. However in 2006 Massachusettes added two new reforms; required all residents to buy insurance or pay a penalty; gave tax credits to certain individuals to ensure they could afford the insurance they were required to buy. The combination of the three reforms reduced Massachusettes uninsured rate to 2.6, the lowest in the country. The Acts three reforms: Each health insurer that offers health insurance coverage in the individual market in a state must accept every individual in that state that applies for coverage and bars insurers from charging higher premiums on the basis of a persons health. Second, the Act by requiring every individual to maintain health coverage or make payment to the IRS minimizes the adverse effect of waiting until one is ill to purchase insurance thereby increasing and broadening the health insurance risk pool to include healthy individuals which will lower health insurance premiums. Third, the Act makes insurance more affordable by giving refundable tax credits to individuals with household incomes between 100% and 400% of the federal poverty line. The huge incentive here is that even if this group of individuals do not have the money to purchase the insurance up front then instead of waiting until the end of the year to receive the tax credits they may pay for the insurance by having the tax credits provided in advance directly to the individuals insurer. Congress found that without tax credit the coverage requirement would not work because the cost of buying insurance would exceed 8% of income for a large segment of the population which would exempt them from coverage. In addition to the reforms the Act requires the creation of an exchange by the states. The Act then provides that the amount of the tax credit depends in part on whether the taxpayer has enrolled in an insurance plan through an exchange established by the state or the HHS. The IRS rule addressed the availability of tax credits by making them available on both state and federal exchanges. The parties in this case dispute whether the act authorizes tax credits for individuals who enroll in an insurance plan through a federal exchange. Whether those credits are available on federal exchanges is thus a question of deep economic and political significance that is central to the statutory scheme and is the courts responsibility to determine the correct reading. Oftentimes the meaning and ambiguity of certain words in their place in the overall statutory scheme may only become evident when placed in context. The duty of the court is to construe statues not isolated provisions.. As such an individual shall only be allowed a tax credit if they enroll in an insurance plan through an exchange established by the state under the Act. Second, the exchange must be established by the state and third the Exchange must be established by the Act. Although phrased as a requirement the Act gives states flexibility by allowing them to elect whether they want to establish an exchange of if the choose not to do so that the Secretary shall establish and operate such Exchange within the State. The court in its interpretation of the statue determined that by using the phrase such exchange directs the federal government to operate exchange that the state was directed to establish therefore a federal exchange counts as an Exchange. Second, the court must determine whether a federal exchange is established by the state especially since the Act defines State to mean each of the 50 states and DC, a definition that does not include the federal government. However, when read in context with a view to its overall statutory scheme, the meaning of the phrase established by the state is not so clear. By instructing the states to establish an exchange it provides that all exchanges shall make available qualified health plans to qualified individuals. The Act then defines a qualified individual as someone who resides in the state that established the exchange. Therein lies the problem because if the court gives the most natural meaning to the phrase State that established the exchange there would be no qualified individuals on federal exchanges. However the Act clearly contemplates that there will be qualified individuals on every exchange. Further the Act instructs the exchanges to consider the interest of qualified individuals and qualified small employers rather than creating separate exchanges for those two groups. The court therefore as part of its analysis determined that those provisions suggest that the Act may not always use the phrase established by the State in its most natural sense. Therefore, the phrase an exchange established by the stateis properly viewed as ambiguous. The phrase may be limited in its reach to state exchanges but it is also possible that the phrase refers to all exchanges, both state and federal for purposes of tax credits. By using the words such exchanges the Act indicates that State and Federal exchanges should be the same. But state and federal exchanges would differ in a fundamental way if tax credits were available only on State exchanges. (The Act does not precisely define what an exchange must look like, so a federal exchange cannot differ from a state exchange) The conclusion is that the Act is Ambiguous on this particular issue, but in looking further into the Act it requires all exchanges to create outreach programs that must distribute fair and important information concerning the availability of premium tax credits as well as establish and make available by electronic means a calculator to determine the actual cost of coverage after the application of any premium tax credit .. Further the Act requires all exchanges to report to the treasury secretary information about each health plan they sell including the aggregate amount of any advance payment of such credit, any information necessary to determine eligibility for and the amount of such credit and any information necessary to determine whether a taxpayer has received excess advance payments. If tax credits were not available on federal exchanges these provisions would make little sense. Congress wrote key parts of the Act behind close doors rather than through the traditional legislative process and Congress passed much of the Act using a complicated budgetary procedure known as reconciliation which limited opportunities for debate and amendment and bypassed the senates normal 60 vote filibuster requirement. As a result the Act does not reflect the type of care and deliberation that one might expect of such significant legislation. Therefor a reading of the Act with all the related provisions in the Act, cannot conclude that the phrase an exchange established by the State under the relevant section of the Act is unambiguous. Section 1311(a)-Assistance to States to establish American Health Benefit Exchanges-Page 130. Section 1311(b)(1)- Each state shall establish an American Health Benefit Exchange- Page 131-132 Section 1311(d)(2)(A)-An exchange shall make available qualified health plans to qualified individuals and qualified employers.-Page 138 Section 1311(6)(A)-(E)-ConsultationAn Exchange shall consult with Stakeholders relevant to carrying out the activities under this Section-Page 144-154 1. After years of attempts and failures what were the two reforms implemented by certain States that caused the increase in premiums and decrease of insured persons? 2. Why did these reforms fail? 3. Why did these same reforms work under the Massachusettes health insurance mandate? Explain. 4. What is the purpose of the tax credit under the Act? 5. Why did the court determine that the phrase An exchange established by the State was ambiguous when interpreted in the context of the overall intent of the Act?